Provider Demographics
NPI:1841455151
Name:KATHLEEN S. LEWANDOWSKI PSYCHOLOGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:KATHLEEN S. LEWANDOWSKI PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-394-1442
Mailing Address - Street 1:3180 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1722
Mailing Address - Country:US
Mailing Address - Phone:585-394-1442
Mailing Address - Fax:585-394-1257
Practice Address - Street 1:3180 WEST ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1722
Practice Address - Country:US
Practice Address - Phone:585-394-1442
Practice Address - Fax:585-394-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010662-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01239436Medicaid
NYBA1529Medicare PIN