Provider Demographics
NPI:1063596583
Name:LEWIS, SARA D (LCSW)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 CAJON ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5955
Mailing Address - Country:US
Mailing Address - Phone:909-307-5777
Mailing Address - Fax:909-307-5776
Practice Address - Street 1:440 CAJON ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5955
Practice Address - Country:US
Practice Address - Phone:909-307-5777
Practice Address - Fax:909-307-5776
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW35066104100000X
CALCS29806104100000X, 1041C0700X
TX646051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker