Provider Demographics
NPI:1679784748
Name:LEWIS, SHAWNNA (LICSW)
Entity type:Individual
Prefix:
First Name:SHAWNNA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 WASHINGTON ST
Mailing Address - Street 2:PO BOX 2726
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6044
Mailing Address - Country:US
Mailing Address - Phone:603-447-2453
Mailing Address - Fax:603-447-2450
Practice Address - Street 1:81 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6044
Practice Address - Country:US
Practice Address - Phone:603-447-2453
Practice Address - Fax:603-447-2450
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30931444Medicaid
NHRE6496Medicare ID - Type Unspecified