Provider Demographics
NPI: | 1942835384 |
---|---|
Name: | LEWIS, LAUREN FRANCES |
Entity Type: | Individual |
Prefix: | |
First Name: | LAUREN |
Middle Name: | FRANCES |
Last Name: | LEWIS |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2275 ARLINGTON DR |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN LEANDRO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94578 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 510-317-1444 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1031 25TH ST |
Practice Address - Street 2: | |
Practice Address - City: | SAN DIEGO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92102-2194 |
Practice Address - Country: | US |
Practice Address - Phone: | 619-578-2211 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2020-03-05 |
Last Update Date: | 2024-01-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 171M00000X | ||
CA | 390200000X, 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |