Provider Demographics
NPI:1104947795
Name:LEWIS, ROBERT DEWITT JR (PSY D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEWITT
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-5704
Mailing Address - Country:US
Mailing Address - Phone:609-695-6370
Mailing Address - Fax:609-695-5809
Practice Address - Street 1:320 W STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-5704
Practice Address - Country:US
Practice Address - Phone:609-695-6370
Practice Address - Fax:609-695-5809
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00371400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8006504Medicaid
NJ029398Medicare ID - Type Unspecified