Provider Demographics
NPI:1215641055
Name:LEWIS1, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:LEWIS1
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 1:276 SWAIN RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-3413
Mailing Address - Country:US
Mailing Address - Phone:781-635-4619
Mailing Address - Fax:
Practice Address - Street 1:90 WASHINGTON ST STE 301B
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3744
Practice Address - Country:US
Practice Address - Phone:603-460-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty