Provider Demographics
NPI:1841894730
Name:LEWIS, AMBER DONNA (BSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DONNA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DONNA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW
Mailing Address - Street 1:138 SAVAGE ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1928
Mailing Address - Country:US
Mailing Address - Phone:860-620-7972
Mailing Address - Fax:
Practice Address - Street 1:225 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4926
Practice Address - Country:US
Practice Address - Phone:888-793-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health