Provider Demographics
NPI:1669267019
Name:LEWIS, IMANI
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7972 POCKET RD APT 122
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5723
Mailing Address - Country:US
Mailing Address - Phone:209-915-2667
Mailing Address - Fax:
Practice Address - Street 1:7972 POCKET RD APT 122
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5723
Practice Address - Country:US
Practice Address - Phone:209-915-2667
Practice Address - Fax:209-915-2667
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician