Provider Demographics
NPI:1548212442
Name:LEVINE, SUSAN L (LCSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2438
Mailing Address - Country:US
Mailing Address - Phone:732-718-3704
Mailing Address - Fax:732-718-3704
Practice Address - Street 1:116 VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5700
Practice Address - Country:US
Practice Address - Phone:732-718-3704
Practice Address - Fax:732-718-3704
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013382001041C0700X
NJ37FI00109900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
151335Medicare PIN