Provider Demographics
NPI:1184871139
Name:LEWANDOWSKI, GRACE
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:ELIZABETH
Other - Last Name:LEWANDOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:14202 BRENTON WOODS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1801
Mailing Address - Country:US
Mailing Address - Phone:210-492-9270
Mailing Address - Fax:
Practice Address - Street 1:14202 BRENTON WOODS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1801
Practice Address - Country:US
Practice Address - Phone:210-492-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional