Provider Demographics
NPI:1982728424
Name:LEWIS, BARRY G (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:G
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 STORRS RD
Mailing Address - Street 2:# 637
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1641
Mailing Address - Country:US
Mailing Address - Phone:860-423-9911
Mailing Address - Fax:
Practice Address - Street 1:126 STORRS RD
Practice Address - Street 2:# 637
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1641
Practice Address - Country:US
Practice Address - Phone:860-423-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001628103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist