Provider Demographics
NPI:1710379557
Name:LEVY, S (MED, MSW)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:MED, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MARVIN RD NE
Mailing Address - Street 2:#307163
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 MARVIN RD NE
Practice Address - Street 2:#307163
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5709
Practice Address - Country:US
Practice Address - Phone:917-254-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW94141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical