Provider Demographics
NPI:1699539031
Name:LEWIS, MEGAN D
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:D
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GUGGISBERG
Mailing Address - Street 1:99 STAFFORD RD STE B-1
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2834
Mailing Address - Country:US
Mailing Address - Phone:860-819-5926
Mailing Address - Fax:
Practice Address - Street 1:99 STAFFORD RD STE B-1
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2834
Practice Address - Country:US
Practice Address - Phone:860-819-5926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist