Provider Demographics
NPI:1255733747
Name:LEWIS, MARSHA DAVIDA X (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:DAVIDA
Last Name:LEWIS
Suffix:X
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:N81W17517 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3672
Mailing Address - Country:US
Mailing Address - Phone:262-345-5685
Mailing Address - Fax:
Practice Address - Street 1:N81W17517 SHADY LN
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3672
Practice Address - Country:US
Practice Address - Phone:262-345-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7145-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical