Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 021928-1 | NY |
NPI | 1073051090 |
---|---|
Provider Name | Dr. Anna Lewis |
First Address | West Islip, NY 11795-4429 |
Second Address | Rockville Centre, NY 11570-3761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2017 |
Last Update Date | 15/10/2018 |