Provider Demographics
NPI:1740358373
Name:LEVINE, PHYLLIS R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:R
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:ROHNDA
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3594 E TREMONT AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:718-792-4178
Mailing Address - Fax:718-792-2496
Practice Address - Street 1:12 WESTCHESTER AVE
Practice Address - Street 2:#4G
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-589-9645
Practice Address - Fax:718-792-2496
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043131011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN735P1Medicare ID - Type Unspecified