Provider Demographics
NPI:1073541884
Name:LEVINE, SUSAN MARSHA (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARSHA
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2450
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:175 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343
Practice Address - Country:US
Practice Address - Phone:781-767-5552
Practice Address - Fax:781-986-8752
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105468104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATX4743OtherMEDICARE PTAN
MATX4743OtherMEDICARE PTAN