Provider Demographics
NPI:1588277800
Name:LEWIS, BRANDY (RBT)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-1026
Mailing Address - Country:US
Mailing Address - Phone:205-902-9236
Mailing Address - Fax:
Practice Address - Street 1:203 S ELMER AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2019
Practice Address - Country:US
Practice Address - Phone:607-221-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician