Provider Demographics
NPI:1215027123
Name:LEVINE, SARA DIANE
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:DIANE
Last Name:LEVINE
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 1:515 PLAINFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2598
Mailing Address - Country:US
Mailing Address - Phone:732-777-1940
Mailing Address - Fax:732-777-1889
Practice Address - Street 1:515 PLAINFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2598
Practice Address - Country:US
Practice Address - Phone:732-777-1940
Practice Address - Fax:732-777-1889
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC007593001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical