Provider Demographics
NPI:1457385486
Name:LEWIS, KATE MARIE BOUCEK (MSW)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:MARIE BOUCEK
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 RICHMOND HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1850
Mailing Address - Country:US
Mailing Address - Phone:703-660-8108
Mailing Address - Fax:703-768-0103
Practice Address - Street 1:6910 RICHMOND HWY STE 110
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1850
Practice Address - Country:US
Practice Address - Phone:703-660-8108
Practice Address - Fax:703-768-0103
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500782261041C0700X
VA09040077431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical