Provider Demographics
NPI:1124697701
Name:LEWIS, SUSAN (AMFT, JD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:AMFT, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2013
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-2013
Mailing Address - Country:US
Mailing Address - Phone:408-409-4167
Mailing Address - Fax:
Practice Address - Street 1:15885 LOS GATOS ALMADEN RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3803
Practice Address - Country:US
Practice Address - Phone:408-393-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor