Provider Demographics
NPI:1740435791
Name:LEWIS, NICOLE RUTH (MHS)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:RUTH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 RODMAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1943
Mailing Address - Country:US
Mailing Address - Phone:610-938-9364
Mailing Address - Fax:
Practice Address - Street 1:800 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-3826
Practice Address - Country:US
Practice Address - Phone:610-938-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool