Provider Demographics
NPI:1104411610
Name:LEWIS, KADIJA AMIRA (BCBA)
Entity type:Individual
Prefix:
First Name:KADIJA
Middle Name:AMIRA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 WISEMAN BLVD APT 9307
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3803
Mailing Address - Country:US
Mailing Address - Phone:210-710-3821
Mailing Address - Fax:
Practice Address - Street 1:419 CARSON HL STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-5500
Practice Address - Country:US
Practice Address - Phone:210-634-1129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 103K00000X
TX4182103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician