Provider Demographics
NPI:1265217764
Name:LEWIS, KRISTIN R (RBT-23-294166)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RBT-23-294166
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13904 NW 270TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-3227
Mailing Address - Country:US
Mailing Address - Phone:386-853-0326
Mailing Address - Fax:
Practice Address - Street 1:4907 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-2006
Practice Address - Country:US
Practice Address - Phone:352-372-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician