Provider Demographics
NPI:1043235039
Name:LEVINE, RON S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:S
Last Name:LEVINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1119
Mailing Address - Country:US
Mailing Address - Phone:518-374-7555
Mailing Address - Fax:518-374-6898
Practice Address - Street 1:246 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1406
Practice Address - Country:US
Practice Address - Phone:518-393-1369
Practice Address - Fax:518-393-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO21214-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB6475Medicare PIN