Provider Demographics
NPI:1003197740
Name:LEVITAN, JUSTIN M (MSW)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:M
Last Name:LEVITAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 S BRYN MAWR AVE
Mailing Address - Street 2:100
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2133
Mailing Address - Country:US
Mailing Address - Phone:610-525-6246
Mailing Address - Fax:610-525-2552
Practice Address - Street 1:234 S BRYN MAWR AVE
Practice Address - Street 2:100
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2133
Practice Address - Country:US
Practice Address - Phone:610-525-6246
Practice Address - Fax:610-525-2552
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-010906-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical