Provider Demographics
NPI:1184714511
Name:LEWIS, LINDA S (LICSW MSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-2104
Mailing Address - Country:US
Mailing Address - Phone:978-546-6102
Mailing Address - Fax:
Practice Address - Street 1:70 HIGH ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-2104
Practice Address - Country:US
Practice Address - Phone:978-546-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
P02719Medicare ID - Type Unspecified