Provider Demographics
NPI:1962746396
Name:LEWIS, JENNIFFER DAWN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFFER
Middle Name:DAWN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7842 VALLEY FLORES DR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-6103
Mailing Address - Country:US
Mailing Address - Phone:818-486-6750
Mailing Address - Fax:
Practice Address - Street 1:22028 VENTURA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1657
Practice Address - Country:US
Practice Address - Phone:818-486-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25358103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical