Provider Demographics
NPI:1114982469
Name:LEWIS, LINDA A (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3138
Mailing Address - Country:US
Mailing Address - Phone:352-372-4868
Mailing Address - Fax:
Practice Address - Street 1:1FLETCHER DR
Practice Address - Street 2:SHCC
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-7500
Practice Address - Country:US
Practice Address - Phone:352-392-1171
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health