Provider Demographics
NPI:1205970746
Name:LEWIN, AMY (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LEWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 CLUBHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4811
Mailing Address - Country:US
Mailing Address - Phone:516-664-1401
Mailing Address - Fax:516-546-1401
Practice Address - Street 1:124 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3434
Practice Address - Country:US
Practice Address - Phone:516-546-1401
Practice Address - Fax:516-546-1401
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027322-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147600OtherVALUE OPTIONS
NYP2081352OtherOXFORD
NY7478504OtherGHI PROVIDER
NYR50381Medicare UPIN
NYP2081352OtherOXFORD