Provider Demographics
NPI:1306906706
Name:LEWIS, JOHN L (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 RIDGELYS CHOICE DR STE 212
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-529-2151
Mailing Address - Fax:410-527-1342
Practice Address - Street 1:875 WEST MORENO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905
Practice Address - Country:US
Practice Address - Phone:719-572-6200
Practice Address - Fax:719-572-6299
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD071531041C0700X
CO16501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKL86OtherBCBS
MDKL86LD02Medicare UPIN
MDKL86OtherBCBS