Provider Demographics
NPI:1982936415
Name:LEWIS, DOROTHY OTNOW I (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:OTNOW
Last Name:LEWIS
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SAINT RONAN TER
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2315
Mailing Address - Country:US
Mailing Address - Phone:203-776-4265
Mailing Address - Fax:203-752-1807
Practice Address - Street 1:100 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5620
Practice Address - Country:US
Practice Address - Phone:203-624-3933
Practice Address - Fax:203-752-1807
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional