Provider Demographics
NPI:1619039393
Name:LEVINE, SHAUN DAVID
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:DAVID
Last Name:LEVINE
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 1:280 N CENTRAL AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1832
Mailing Address - Country:US
Mailing Address - Phone:914-328-2557
Mailing Address - Fax:
Practice Address - Street 1:280 N CENTRAL AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1832
Practice Address - Country:US
Practice Address - Phone:914-328-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0696041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical