Provider Demographics
NPI:1689623480
Name:LEVINE, ILENE G (LMHC)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:G
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ONYX DR
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3521
Mailing Address - Country:US
Mailing Address - Phone:508-982-4755
Mailing Address - Fax:
Practice Address - Street 1:25W OLD WESTPORT RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2513
Practice Address - Country:US
Practice Address - Phone:508-982-4755
Practice Address - Fax:877-308-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health