Provider Demographics
NPI:1780407098
Name:LEWIS-SMALE, STEPHANIE R (LMSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:LEWIS-SMALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9031
Mailing Address - Street 2:
Mailing Address - City:CHANDLER HEIGHTS
Mailing Address - State:AZ
Mailing Address - Zip Code:85127-9031
Mailing Address - Country:US
Mailing Address - Phone:480-331-4031
Mailing Address - Fax:
Practice Address - Street 1:1250 W WASHINGTON ST # 215
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-1697
Practice Address - Country:US
Practice Address - Phone:602-842-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-175411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty