Provider Demographics
NPI:1104057660
Name:LEWIS-WHITE, SHARI M (LCSW, BCABA)
Entity type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:M
Last Name:LEWIS-WHITE
Suffix:
Gender:F
Credentials:LCSW, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 S PATRICK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3963
Mailing Address - Country:US
Mailing Address - Phone:321-779-0213
Mailing Address - Fax:321-773-0497
Practice Address - Street 1:1275 S PATRICK DR
Practice Address - Street 2:STE C
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3963
Practice Address - Country:US
Practice Address - Phone:321-779-0213
Practice Address - Fax:321-773-0497
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-01-0238103K00000X
FLSW79371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty