Provider Demographics
NPI:1407912546
Name:LEVIN, STACY P (MSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:P
Last Name:LEVIN
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 1:73 MILL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3080
Mailing Address - Country:US
Mailing Address - Phone:614-478-9309
Mailing Address - Fax:614-478-9323
Practice Address - Street 1:73 MILL ST
Practice Address - Street 2:SUITE A
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3080
Practice Address - Country:US
Practice Address - Phone:614-478-9309
Practice Address - Fax:614-478-9323
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00039621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical