Provider Demographics
NPI:1295942241
Name:SPEAKES-LEWIS, AMANDIA (LCSW-R, PHD)
Entity type:Individual
Prefix:DR
First Name:AMANDIA
Middle Name:
Last Name:SPEAKES-LEWIS
Suffix:
Gender:F
Credentials:LCSW-R, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11582-0311
Mailing Address - Country:US
Mailing Address - Phone:516-341-7094
Mailing Address - Fax:516-515-7405
Practice Address - Street 1:121 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3822
Practice Address - Country:US
Practice Address - Phone:516-341-7094
Practice Address - Fax:516-515-7405
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2014-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055205R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9H492Medicare PIN