Provider Demographics
NPI:1629202916
Name:LEVINE, MELANIE ETTAFAITH (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ETTAFAITH
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1 EMERALD RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1560
Mailing Address - Country:US
Mailing Address - Phone:410-218-7053
Mailing Address - Fax:443-817-0844
Practice Address - Street 1:1190 W NORTHERN PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1431
Practice Address - Country:US
Practice Address - Phone:410-218-7053
Practice Address - Fax:443-817-0844
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical