Provider Demographics
NPI:1932547288
Name:LEWIS, MADELINE (LC7507)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LC7507
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 MAIN ST # 13
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1528
Mailing Address - Country:US
Mailing Address - Phone:207-558-2257
Mailing Address - Fax:
Practice Address - Street 1:445 MAIN ST # 13
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1528
Practice Address - Country:US
Practice Address - Phone:207-558-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7507101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)