Provider Demographics
NPI:1215185129
Name:FREDERICK A. LEVY LCSW, LTD.
Entity Type:Organization
Organization Name:FREDERICK A. LEVY LCSW, LTD.
Other - Org Name:FREDERICK A. LEVY LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-873-1240
Mailing Address - Street 1:732 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 702
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4218
Mailing Address - Country:US
Mailing Address - Phone:757-873-1240
Mailing Address - Fax:757-873-4915
Practice Address - Street 1:732 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 702
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4218
Practice Address - Country:US
Practice Address - Phone:757-873-1240
Practice Address - Fax:757-873-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040009431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAR6012Medicare PIN
VA800002828Medicare PIN