Provider Demographics
NPI:1598356644
Name:LEWIS, MELISA SIMONE
Entity type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:SIMONE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:SIMONE
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:279 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7813
Mailing Address - Country:US
Mailing Address - Phone:212-749-1820
Mailing Address - Fax:
Practice Address - Street 1:1133 WESTCHESTER AVE # N230
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3516
Practice Address - Country:US
Practice Address - Phone:347-528-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY1096500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty