Provider Demographics
NPI:1902082043
Name:LEWIS, ROBERT L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 CLAYTON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1353
Mailing Address - Country:US
Mailing Address - Phone:314-664-2999
Mailing Address - Fax:314-645-6708
Practice Address - Street 1:7750 CLAYTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1353
Practice Address - Country:US
Practice Address - Phone:314-664-2999
Practice Address - Fax:314-645-6708
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00296103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical