Provider Demographics
NPI:1659448207
Name:LEWIS, GRETCHEN ELIZABETH (LCMHC CASAC)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCMHC CASAC
Other - Prefix:MRS
Other - First Name:GRETCHEN
Other - Middle Name:ELIZABETH
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1517 PARKER ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855
Mailing Address - Country:US
Mailing Address - Phone:802-754-2986
Mailing Address - Fax:
Practice Address - Street 1:194 MAIN STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855
Practice Address - Country:US
Practice Address - Phone:802-334-8834
Practice Address - Fax:802-334-5655
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT103869101YA0400X
VT0680000569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009883Medicaid
VT1596688OtherBCBS
VT1596688OtherCIGNA