Basic Information
| Provider Information | |||||||||
| NPI: | 1447733340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ELISSA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2369 26TH ST APT 2 | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111053118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163203915 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1847 MOTT AVE | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116914201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183376800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2018 | ||||||||
| LastUpdateDate: | 09/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 103987-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.