Provider Demographics
NPI:1245632124
Name:LEWIS-JAH, MARGO LEONA (PHD, LCSW, MED, MO)
Entity type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:LEONA
Last Name:LEWIS-JAH
Suffix:
Gender:F
Credentials:PHD, LCSW, MED, MO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 DUMONT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-1001
Mailing Address - Country:US
Mailing Address - Phone:610-800-9524
Mailing Address - Fax:
Practice Address - Street 1:301 OLD DUPONT RD STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1084
Practice Address - Country:US
Practice Address - Phone:302-503-2273
Practice Address - Fax:302-351-6830
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0187141041C0700X
DEQ1-00014151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical