Provider Demographics
NPI:1942336573
Name:LEWIS, PEGGY (LISW)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 W 5TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1905
Mailing Address - Country:US
Mailing Address - Phone:614-488-6285
Mailing Address - Fax:614-875-4121
Practice Address - Street 1:1971 W 5TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1905
Practice Address - Country:US
Practice Address - Phone:614-488-6285
Practice Address - Fax:614-875-4121
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0002684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW23891Medicare ID - Type Unspecified