Provider Demographics
NPI:1396238754
Name:TEPPER-LEWIS, CALLIE (LCAT)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:TEPPER-LEWIS
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 LAKEVIEW AVE W
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6418
Mailing Address - Country:US
Mailing Address - Phone:301-943-2176
Mailing Address - Fax:
Practice Address - Street 1:62 LAKEVIEW AVE W
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-6418
Practice Address - Country:US
Practice Address - Phone:301-943-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP07229225600000X
NY002333225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist