Provider Demographics
NPI:1205835295
Name:LEVINSON, ANDREA (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 A1A S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6591
Mailing Address - Country:US
Mailing Address - Phone:904-471-1414
Mailing Address - Fax:320-205-6519
Practice Address - Street 1:2180 A1A S
Practice Address - Street 2:SUITE 201
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6591
Practice Address - Country:US
Practice Address - Phone:904-471-1414
Practice Address - Fax:320-205-6519
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW64441041C0700X
MASLW10170071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0764Medicare ID - Type Unspecified
FLU0764AMedicare UPIN