Provider Demographics
NPI:1962462754
Name:LEWIS, ROBERT W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E. WINROW AVE.
Mailing Address - Street 2:
Mailing Address - City:FT. HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613
Mailing Address - Country:US
Mailing Address - Phone:520-533-5161
Mailing Address - Fax:520-533-5715
Practice Address - Street 1:2240 E. WINROW AVE.
Practice Address - Street 2:
Practice Address - City:FT. HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613
Practice Address - Country:US
Practice Address - Phone:520-533-5161
Practice Address - Fax:520-533-5715
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 1392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical