Provider Demographics
NPI:1720425432
Name:LEWIS, VANESSA (CPM, CLC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CPM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 MAIN ST STE 1RR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-1784
Mailing Address - Country:US
Mailing Address - Phone:774-633-9663
Mailing Address - Fax:800-467-3580
Practice Address - Street 1:351 MAIN ST STE 1RR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-1784
Practice Address - Country:US
Practice Address - Phone:774-633-9663
Practice Address - Fax:800-467-3580
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X, 374J00000X
MA176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula