Provider Demographics
NPI:1205244647
Name:LEWIS, CARMEN JULIA (PSYD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:JULIA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W MINER ST
Mailing Address - Street 2:APT 1 R
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-3239
Mailing Address - Country:US
Mailing Address - Phone:215-808-5858
Mailing Address - Fax:
Practice Address - Street 1:920 E BALTIMORE PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1800
Practice Address - Country:US
Practice Address - Phone:610-388-7400
Practice Address - Fax:610-388-7404
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017634103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist