Provider Demographics
NPI:1124049986
Name:LEWIS, VANESSA MARIA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARIA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24760 ARSENAL
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134
Mailing Address - Country:US
Mailing Address - Phone:734-782-1641
Mailing Address - Fax:
Practice Address - Street 1:20600 EUREKA
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:734-285-8282
Practice Address - Fax:734-281-0402
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058924104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26429060Medicare ID - Type Unspecified