Provider Demographics
NPI:1093551988
Name:LEWIN, SHELLY MARK (LCSW)
Entity type:Individual
Prefix:MR
First Name:SHELLY
Middle Name:MARK
Last Name:LEWIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:SHELDON
Other - Middle Name:MARK
Other - Last Name:LEWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1900 CENTRE POINTE BLVD APT 100
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4878
Mailing Address - Country:US
Mailing Address - Phone:773-968-1960
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRE POINTE BLVD APT 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4878
Practice Address - Country:US
Practice Address - Phone:773-968-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490078971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical