Provider Demographics
NPI:1568528123
Name:LEVINE, BEVERLY P (MSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:P
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2107
Mailing Address - Country:US
Mailing Address - Phone:973-665-9566
Mailing Address - Fax:973-665-9567
Practice Address - Street 1:19 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2107
Practice Address - Country:US
Practice Address - Phone:973-665-9566
Practice Address - Fax:973-665-9567
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001532001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ839477Medicare ID - Type Unspecified