Provider Demographics
NPI:1720620271
Name:LEWIS, CHERYL PAMELA
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:PAMELA
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 1:155 NORTHAMPTON ST APT 408
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1845
Mailing Address - Country:US
Mailing Address - Phone:617-291-5678
Mailing Address - Fax:
Practice Address - Street 1:155 NORTHAMPTON ST APT 408
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1845
Practice Address - Country:US
Practice Address - Phone:617-291-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health