Provider Demographics
NPI:1063774792
Name:DEUEL-LEWIS, BOBBIE JO
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JO
Last Name:DEUEL-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2430
Mailing Address - Country:US
Mailing Address - Phone:607-754-1101
Mailing Address - Fax:
Practice Address - Street 1:116 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2430
Practice Address - Country:US
Practice Address - Phone:607-754-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0951421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical