Provider Demographics
NPI:1194245589
Name:LEWIN, CLINTON JARED (PSYD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:JARED
Last Name:LEWIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 BALTIMORE NATIONAL PIKE STE 170A-168
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3930
Mailing Address - Country:US
Mailing Address - Phone:410-703-6784
Mailing Address - Fax:443-498-9431
Practice Address - Street 1:839 ELKRIDGE LANDING RD STE 211
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2946
Practice Address - Country:US
Practice Address - Phone:410-703-6784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
MD05951103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05951OtherLICENSED PSYCHOLOGIST