Provider Demographics
NPI:1467531699
Name:LEVIN, NICOLE F (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:F
Last Name:LEVIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SPRINGDALE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2763
Mailing Address - Country:US
Mailing Address - Phone:856-424-1333
Mailing Address - Fax:856-424-7384
Practice Address - Street 1:702 BIRCHFIELD DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4020
Practice Address - Country:US
Practice Address - Phone:856-778-7775
Practice Address - Fax:856-778-7710
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC0519741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072153Medicare ID - Type UnspecifiedMEDICARE