Individual
KELLY LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
55 WESTCHESTER SQ, BRONX, NY 10461-3525
(347) 901-6612
Mailing address
55 WESTCHESTER SQ, BRONX, NY 10461-3525
(347) 901-6612
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122801
—
NY
Enumeration date
11/27/2019
Last updated
11/27/2019
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