Provider Demographics
NPI:1437688173
Name:LEWIS, SUSANNA REBECCA (LCSW-C)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:REBECCA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WASHINGTON AVENUE
Mailing Address - Street 2:FLOOR 5 #35
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 WASHINGTON AVENUE
Practice Address - Street 2:FLOOR 5 #35
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4718
Practice Address - Country:US
Practice Address - Phone:443-454-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD180211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical