Provider Demographics
NPI:1336999192
Name:LEWANDOWSKI, KASEY J (LPCC)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:J
Last Name:LEWANDOWSKI
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 32ND ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3752
Mailing Address - Country:US
Mailing Address - Phone:414-405-2759
Mailing Address - Fax:
Practice Address - Street 1:2635 CAMINO DEL RIO S STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3728
Practice Address - Country:US
Practice Address - Phone:414-405-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional