Provider Demographics
NPI:1457098857
Name:LEWIS, LETISHA N (LCSW)
Entity type:Individual
Prefix:
First Name:LETISHA
Middle Name:N
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LETISHA
Other - Middle Name:N
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:861 NW 167TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5319
Mailing Address - Country:US
Mailing Address - Phone:786-436-2328
Mailing Address - Fax:
Practice Address - Street 1:861 NW 167TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-5319
Practice Address - Country:US
Practice Address - Phone:786-436-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL190791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical