Provider Demographics
NPI:1962875534
Name:LEWIS, MARGOT MCGRATH (PSYD)
Entity type:Individual
Prefix:MRS
First Name:MARGOT
Middle Name:MCGRATH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:MARGOT
Other - Middle Name:GARRETT
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:206 WESTOVER AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-2304
Mailing Address - Country:US
Mailing Address - Phone:301-442-3867
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAN/AOtherTRICARE