Provider Demographics
NPI:1609181312
Name:LEVIN, LOUISE (LMFT, MSED)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:LMFT, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:GREENS FARMS
Mailing Address - State:CT
Mailing Address - Zip Code:06838-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 BEACHSIDE AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-6207
Practice Address - Country:US
Practice Address - Phone:203-259-8036
Practice Address - Fax:203-259-6542
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001101106H00000X
NY000769-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist