Provider Demographics
NPI:1396286464
Name:LEWIS, PETER (LCSW)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LCSW
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 21975
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4116
Mailing Address - Country:US
Mailing Address - Phone:540-321-4281
Mailing Address - Fax:540-321-4282
Practice Address - Street 1:608 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3210
Practice Address - Country:US
Practice Address - Phone:540-825-4557
Practice Address - Fax:540-825-4566
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040106511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ61316AOtherMEDICARE
VA0904010651OtherLICENSE
VA1396286464Medicaid