Provider Demographics
NPI:1497852834
Name:LEVISON, BRUCE E (LCSW, MSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:E
Last Name:LEVISON
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVERVIEW CENTER, STE. 314
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-346-6020
Mailing Address - Fax:860-346-6023
Practice Address - Street 1:100 RIVERVIEW CENTER, STE 314
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-346-6020
Practice Address - Fax:860-346-6023
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health