Provider Demographics
NPI:1932363256
Name:LEWIS, BROEK WILLIAMS (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:BROEK
Middle Name:WILLIAMS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:BROEK
Other - Middle Name:ERIN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:401 HOWARD STREET
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001
Mailing Address - Country:US
Mailing Address - Phone:269-383-9055
Mailing Address - Fax:269-383-9108
Practice Address - Street 1:401 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001
Practice Address - Country:US
Practice Address - Phone:269-383-9055
Practice Address - Fax:269-383-9108
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010901851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical