Provider Demographics
NPI:1275797011
Name:LEVINSON, RALPH (EDD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N HIATUS RD
Mailing Address - Street 2:SUITE: 160
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3097
Mailing Address - Country:US
Mailing Address - Phone:954-431-9838
Mailing Address - Fax:954-433-7066
Practice Address - Street 1:1000 N HIATUS RD
Practice Address - Street 2:SUITE: 160
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3097
Practice Address - Country:US
Practice Address - Phone:954-431-9838
Practice Address - Fax:954-433-7066
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3131104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW3131OtherLICENSE