Provider Demographics
NPI:1548546344
Name:LEWIS, MYKEISHA J (LCSW)
Entity type:Individual
Prefix:
First Name:MYKEISHA
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 BIG BEAR RD
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-5222
Mailing Address - Country:US
Mailing Address - Phone:925-329-5949
Mailing Address - Fax:
Practice Address - Street 1:4631 BIG BEAR RD
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-5222
Practice Address - Country:US
Practice Address - Phone:925-329-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87244390200000X
CA1140761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program