Provider Demographics
NPI:1699460246
Name:LEWIS, NAOMI NESSE
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:NESSE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11921 ROCKVILLE PIKE STE 402
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2757
Mailing Address - Country:US
Mailing Address - Phone:571-887-6858
Mailing Address - Fax:
Practice Address - Street 1:1121 UNIVERSITY BLVD W APT 104
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3317
Practice Address - Country:US
Practice Address - Phone:301-332-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104013893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health