Provider Demographics
NPI:1467520510
Name:LEVINE, ELLEN RUTH (LCSW R)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:RUTH
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WEST 98 STREET
Mailing Address - Street 2:APT 7D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:646-239-0221
Mailing Address - Fax:212-726-0937
Practice Address - Street 1:1841 BROADWAY FOURTH FLOOR
Practice Address - Street 2:CO ICP
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:646-239-0221
Practice Address - Fax:212-333-5444
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0423851103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist