Provider Demographics
NPI:1376779421
Name:LEVENSON, KATHRYN KAY (BA, LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:KAY
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:BA, LMSW
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:KAY
Other - Last Name:IRISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, LMSW
Mailing Address - Street 1:1400 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2651
Mailing Address - Country:US
Mailing Address - Phone:248-658-1116
Mailing Address - Fax:248-658-1120
Practice Address - Street 1:1400 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2651
Practice Address - Country:US
Practice Address - Phone:248-658-1116
Practice Address - Fax:248-658-1120
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker