Provider Demographics
NPI:1144292228
Name:CARR, LEWIS CHARLES (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:CHARLES
Last Name:CARR
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:CHARLES
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, ABPP
Mailing Address - Street 1:4929 WILSHIRE BLVD
Mailing Address - Street 2:SUITE NUMBER 510
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3808
Mailing Address - Country:US
Mailing Address - Phone:562-904-3999
Mailing Address - Fax:855-688-6746
Practice Address - Street 1:4929 WILSHIRE BLVD
Practice Address - Street 2:SUITE NUMBER 510
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3808
Practice Address - Country:US
Practice Address - Phone:562-904-3999
Practice Address - Fax:855-688-6746
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2150103TC0700X
CAPSY26808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000491Medicaid
NC2815505AMedicare ID - Type UnspecifiedABPP LEVEL PROVIDER