Provider Demographics
NPI:1124049556
Name:LEWIS, ROXANNE ANGELA (PHD)
Entity type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:ANGELA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 COUNTY LINE RD W
Mailing Address - Street 2:STE 225
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6918
Mailing Address - Country:US
Mailing Address - Phone:614-985-3649
Mailing Address - Fax:614-985-3601
Practice Address - Street 1:200 E CAMPUS VIEW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4678
Practice Address - Country:US
Practice Address - Phone:614-985-3649
Practice Address - Fax:614-985-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3428103G00000X
MA3574103TC0700X
WA60009283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP03065Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER