Provider Demographics
NPI:1588847453
Name:LEVITT, LANCE RUSSELL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:RUSSELL
Last Name:LEVITT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15A SHERIDAN SQUARE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6847
Mailing Address - Country:US
Mailing Address - Phone:212-675-7524
Mailing Address - Fax:
Practice Address - Street 1:15A SHERIDAN SQUARE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6847
Practice Address - Country:US
Practice Address - Phone:212-675-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0514141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical