Provider Demographics
NPI:1750350187
Name:LEW, ANGELA S (HSPP)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:S
Last Name:LEW
Suffix:
Gender:F
Credentials:HSPP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:S
Other - Last Name:LEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8770 W BRYN MAWR AVE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3515
Mailing Address - Country:US
Mailing Address - Phone:877-807-5120
Mailing Address - Fax:708-460-4120
Practice Address - Street 1:8770 W BRYN MAWR AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3515
Practice Address - Country:US
Practice Address - Phone:877-807-5120
Practice Address - Fax:708-460-4120
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041121A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200200710AMedicaid
ILK46442OtherMEDICARE PTAN
IN237590RMedicare ID - Type Unspecified