Provider Demographics
NPI:1417018821
Name:LEVINE, CAROL K (MSW CSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:K
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MSW CSW
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:K
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW CSW
Mailing Address - Street 1:5 RIVERSIDE DRIVE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2534
Mailing Address - Country:US
Mailing Address - Phone:212-787-4312
Mailing Address - Fax:
Practice Address - Street 1:5 RIVERSIDE DRIVE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2534
Practice Address - Country:US
Practice Address - Phone:212-787-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO3111 2 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN14521Medicare ID - Type Unspecified