Individual
ALICIA ELIZABETH LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 DUDLEY ST, ROXBURY, MA 02119-2769
(617) 989-9499
Mailing address
24 WACHUSETT ST APT 1, HYDE PARK, MA 02136-6446
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100049498791
MASSHEALTH
MA
Enumeration date
06/27/2017
Last updated
06/27/2017
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