Provider Demographics
NPI:1093016255
Name:LEVNER, LEO (SOCIAL WORK INTERN)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:
Last Name:LEVNER
Suffix:
Gender:M
Credentials:SOCIAL WORK INTERN
Other - Prefix:MR
Other - First Name:LEO
Other - Middle Name:
Other - Last Name:LEVNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORK INTERN
Mailing Address - Street 1:845 CENTRAL AVE
Mailing Address - Street 2:SOUTH 3
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1514
Mailing Address - Country:US
Mailing Address - Phone:518-482-2455
Mailing Address - Fax:518-482-2458
Practice Address - Street 1:845 CENTRAL AVENUE
Practice Address - Street 2:3 SOUTH
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206
Practice Address - Country:US
Practice Address - Phone:518-482-2455
Practice Address - Fax:518-482-2458
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker