Provider Demographics
NPI:1164961496
Name:LEVINE, CARLYE JOHNSTON (LCSW, C-ASWCM)
Entity Type:Individual
Prefix:MRS
First Name:CARLYE
Middle Name:JOHNSTON
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCSW, C-ASWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 110S
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2327
Mailing Address - Country:US
Mailing Address - Phone:512-250-1043
Mailing Address - Fax:512-257-7179
Practice Address - Street 1:11940 JOLLYVILLE RD
Practice Address - Street 2:SUITE 110S
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2327
Practice Address - Country:US
Practice Address - Phone:512-250-1043
Practice Address - Fax:512-257-7179
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX523381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical