Provider Demographics
NPI:1093747313
Name:LEVY, SUE (PSYD LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:PSYD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 S NOVA ROAD
Mailing Address - Street 2:BLDG B SUITE 23
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9229
Mailing Address - Country:US
Mailing Address - Phone:386-253-8439
Mailing Address - Fax:386-253-8579
Practice Address - Street 1:3959 S NOVA ROAD
Practice Address - Street 2:BLDG B SUITE 23
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9229
Practice Address - Country:US
Practice Address - Phone:386-253-8439
Practice Address - Fax:386-253-8579
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00025131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R99283Medicare UPIN
FLZ3751AMedicare ID - Type Unspecified