Provider Demographics
NPI:1083060313
Name:LEVIN, RAPHAEL DON (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:DON
Last Name:LEVIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-0104
Mailing Address - Country:US
Mailing Address - Phone:248-703-9155
Mailing Address - Fax:248-594-4992
Practice Address - Street 1:31000 TELEGRAPH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4360
Practice Address - Country:US
Practice Address - Phone:248-594-4991
Practice Address - Fax:248-594-4992
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010116491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical