Provider Demographics
NPI:1528553286
Name:LEVIN, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LEVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1086
Mailing Address - Country:US
Mailing Address - Phone:330-467-7131
Mailing Address - Fax:330-467-7168
Practice Address - Street 1:37 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1910
Practice Address - Country:US
Practice Address - Phone:330-535-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1Medicaid