Provider Demographics
NPI:1457061517
Name:LEWIS, MEGAN (LICSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2116
Mailing Address - Country:US
Mailing Address - Phone:207-287-2010
Mailing Address - Fax:507-287-2010
Practice Address - Street 1:4600 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2116
Practice Address - Country:US
Practice Address - Phone:507-287-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical