Provider Demographics
NPI:1710044896
Name:LEVY, MARLENE L (LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:L
Last Name:LEVY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OAK TREE CT
Mailing Address - Street 2:
Mailing Address - City:SANDS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1118
Mailing Address - Country:US
Mailing Address - Phone:516-944-3885
Mailing Address - Fax:516-944-3885
Practice Address - Street 1:7 OAK TREE CT
Practice Address - Street 2:
Practice Address - City:SANDS POINT
Practice Address - State:NY
Practice Address - Zip Code:11050-1118
Practice Address - Country:US
Practice Address - Phone:516-944-3885
Practice Address - Fax:516-944-3885
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028502-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN11101Medicare ID - Type UnspecifiedMEDICARE MENTAL HEALTH CA