Provider Demographics
NPI:1871345512
Name:FREISSLE-LEWIS, MONICA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:FREISSLE-LEWIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 W VILLAGE DR UNIT 6096
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-3429
Mailing Address - Country:US
Mailing Address - Phone:813-474-7734
Mailing Address - Fax:
Practice Address - Street 1:3317 W CASS ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1411
Practice Address - Country:US
Practice Address - Phone:813-474-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11987103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical