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Individual

DIANE M DERR LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
3425 EXECUTIVE PKWY, SUITE 230, TOLEDO, OH 43606-1326
(419) 531-3500
(419) 531-1877
Mailing address
PO BOX 74872, CLEVELAND, OH 44194-0002
(419) 531-3500
(419) 531-1877

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5384
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000388012
ANTHEM INDIVIDUAL PROV #
OH
01
03023
PARAMOUNT INDIVIDUAL PR
OH
05
0911811
OH
01
267100000
AETNA PROV #
OH
Enumeration date
01/04/2007
Last updated
05/01/2012
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