Provider Demographics
NPI:1912412529
Name:LEWIS, SAMANTHA (LISW-S)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:
Credentials:LISW-S
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 E MOUND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5540
Mailing Address - Country:US
Mailing Address - Phone:614-722-2000
Mailing Address - Fax:
Practice Address - Street 1:525 E MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5540
Practice Address - Country:US
Practice Address - Phone:614-722-2000
Practice Address - Fax:614-355-5594
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1700746-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0261536Medicaid