Provider Demographics
NPI:1730244831
Name:LEWIS, JONATHAN D (PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3526 SILVERSIDE RD
Mailing Address - Street 2:SUITE 36
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4911
Mailing Address - Country:US
Mailing Address - Phone:302-479-5060
Mailing Address - Fax:302-479-5061
Practice Address - Street 1:3526 SILVERSIDE RD
Practice Address - Street 2:SUITE 36
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4911
Practice Address - Country:US
Practice Address - Phone:302-479-5060
Practice Address - Fax:302-479-5061
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE102389Medicare ID - Type UnspecifiedPSYCHOLOGY