Provider Demographics
NPI:1124626981
Name:LEWIS, CAROLYN MARIE (CSAC)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N92W17420 APPLETON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-1363
Mailing Address - Country:US
Mailing Address - Phone:414-367-8025
Mailing Address - Fax:
Practice Address - Street 1:N92W17420 APPLETON AVE STE 103
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-1363
Practice Address - Country:US
Practice Address - Phone:414-367-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17071101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)