Provider Demographics
NPI:1104138239
Name:LEWIS, CHARLENE TRAVIESO (LCSW,CAP,CST)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:TRAVIESO
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW,CAP,CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1029
Mailing Address - Country:US
Mailing Address - Phone:786-290-0935
Mailing Address - Fax:
Practice Address - Street 1:7344 SW 48TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5546
Practice Address - Country:US
Practice Address - Phone:786-290-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP-4255101YA0400X
FLSW93061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical