Provider Demographics
NPI:1164924346
Name:LEVIN, ALEXANDER ISRAEL
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ISRAEL
Last Name:LEVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NORHARDT DR APT 102
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5098
Mailing Address - Country:US
Mailing Address - Phone:262-470-6679
Mailing Address - Fax:
Practice Address - Street 1:9653 N GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-3513
Practice Address - Country:US
Practice Address - Phone:262-404-7509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health