Provider Demographics
NPI:1710013164
Name:LEVY, NONNY CANGELOSI (LICENSED INDEPENDENT)
Entity Type:Individual
Prefix:
First Name:NONNY
Middle Name:CANGELOSI
Last Name:LEVY
Suffix:
Gender:F
Credentials:LICENSED INDEPENDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BIRCHWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-4907
Mailing Address - Country:US
Mailing Address - Phone:781-259-1292
Mailing Address - Fax:
Practice Address - Street 1:227 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:781-259-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1050721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical