Provider Demographics
NPI:1255051736
Name:LEWIS, AMANDA RUTH (LGSW)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RUTH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:RUTH
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 E CAPITOL ST NE APT E44
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3322
Mailing Address - Country:US
Mailing Address - Phone:703-589-0239
Mailing Address - Fax:
Practice Address - Street 1:6010 EXECUTIVE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3822
Practice Address - Country:US
Practice Address - Phone:240-447-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200001672104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker