Provider Demographics
NPI:1548332240
Name:LEWIS, GERALD W (PHD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 WORCESTER RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5254
Mailing Address - Country:US
Mailing Address - Phone:508-872-6228
Mailing Address - Fax:508-370-7282
Practice Address - Street 1:1290 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5254
Practice Address - Country:US
Practice Address - Phone:508-872-6228
Practice Address - Fax:508-370-7282
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY-2096-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02312OtherBLUE CROSS BLUE SHIELD
701415OtherTUFTS
MAW02312OtherBLUE CROSS BLUE SHIELD