Provider Demographics
NPI:1215260609
Name:PATRICIA LEWIS-SLAYTON, LCSW LMFT. INC
Entity type:Organization
Organization Name:PATRICIA LEWIS-SLAYTON, LCSW LMFT. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS-SLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LMFT
Authorized Official - Phone:904-822-7733
Mailing Address - Street 1:2112 W. LYMINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084
Mailing Address - Country:US
Mailing Address - Phone:904-824-7733
Mailing Address - Fax:
Practice Address - Street 1:1100 S PONCE DE LEON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6013
Practice Address - Country:US
Practice Address - Phone:904-824-7733
Practice Address - Fax:904-829-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW15941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty