Provider Demographics
NPI:1760001309
Name:LEWIS, CHRISTOPHER ROY (CASAC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10038 194TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3220
Mailing Address - Country:US
Mailing Address - Phone:646-643-4903
Mailing Address - Fax:
Practice Address - Street 1:10038 194TH ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-3220
Practice Address - Country:US
Practice Address - Phone:646-643-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)