Basic Information
| Provider Information | |||||||||
| NPI: | 1275797011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVINSON | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | |||||||||
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| Credential: | EDD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 N HIATUS RD | ||||||||
| Address2: | SUITE: 160 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330263097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544319838 | ||||||||
| FaxNumber: | 9544337066 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N HIATUS RD | ||||||||
| Address2: | SUITE: 160 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330263097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544319838 | ||||||||
| FaxNumber: | 9544337066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2008 | ||||||||
| LastUpdateDate: | 07/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW3131 | FL | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | SW3131 | 01 | FL | LICENSE | OTHER |