Provider Demographics
NPI:1164983466
Name:LEVIN, VANESSA FAYE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:FAYE
Last Name:LEVIN
Suffix:
Gender:F
Credentials:
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 313
Mailing Address - Street 2:
Mailing Address - City:ROLLINSFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03869-0313
Mailing Address - Country:US
Mailing Address - Phone:603-674-5206
Mailing Address - Fax:
Practice Address - Street 1:3 FRONT ST
Practice Address - Street 2:#355
Practice Address - City:ROLLINSFORD
Practice Address - State:NH
Practice Address - Zip Code:03869
Practice Address - Country:US
Practice Address - Phone:603-674-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health