Provider Demographics
NPI:1881103596
Name:LEWIS, KAYLA M (LPC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 WORTHINGTON RDG
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3241
Mailing Address - Country:US
Mailing Address - Phone:602-124-4473
Mailing Address - Fax:
Practice Address - Street 1:858 WORTHINGTON RDG
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3241
Practice Address - Country:US
Practice Address - Phone:860-212-4473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid