Provider Demographics
NPI:1356420749
Name:LEWIS, ELIZABETH A (LCSW, RN)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-2421
Mailing Address - Country:US
Mailing Address - Phone:845-679-4200
Mailing Address - Fax:845-679-4360
Practice Address - Street 1:5 PLAYHOUSE LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1609
Practice Address - Country:US
Practice Address - Phone:845-679-9200
Practice Address - Fax:845-679-4360
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046718-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02314574Medicaid
NYN9G751Medicare ID - Type Unspecified
NY02314574Medicaid