Provider Demographics
NPI:1255972501
Name:LEWIS, SHANTELL (RBT)
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 WHITE HORSE MERCERVILLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-1407
Mailing Address - Country:US
Mailing Address - Phone:609-581-3800
Mailing Address - Fax:866-513-0868
Practice Address - Street 1:941 WHITE HORSE MERCERVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-1407
Practice Address - Country:US
Practice Address - Phone:609-581-3800
Practice Address - Fax:866-513-0868
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-56110103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst