Provider Demographics
NPI:1417542432
Name:LEVENSON, AJA (LMSW)
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 ROUTE 146 STE 101
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3239
Mailing Address - Country:US
Mailing Address - Phone:518-373-3924
Mailing Address - Fax:518-373-3808
Practice Address - Street 1:3 CROSSING BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4172
Practice Address - Country:US
Practice Address - Phone:518-831-4434
Practice Address - Fax:518-831-4435
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111708104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker