Provider Demographics
NPI:1811254238
Name:LEWIS, KIMBERLEY ANN (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 HYLAN BLVD # 1275
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2110
Mailing Address - Country:US
Mailing Address - Phone:929-724-3878
Mailing Address - Fax:
Practice Address - Street 1:1885 HYLAN BLVD # 1275
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2110
Practice Address - Country:US
Practice Address - Phone:929-724-3878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057948001041C0700X
NY0800951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical