Provider Demographics
NPI:1194448746
Name:LEWIS, DEANGELO JULIAN
Entity type:Individual
Prefix:
First Name:DEANGELO
Middle Name:JULIAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2247
Mailing Address - Country:US
Mailing Address - Phone:947-217-8082
Mailing Address - Fax:
Practice Address - Street 1:2580 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-2247
Practice Address - Country:US
Practice Address - Phone:947-217-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician