Provider Demographics
NPI:1740382423
Name:LEVIN, JEFFREY S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:LEVIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E ST
Mailing Address - Street 2:STE 206
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-258-9559
Mailing Address - Fax:415-887-2552
Practice Address - Street 1:700 E ST
Practice Address - Street 2:STE 206
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-258-9559
Practice Address - Fax:415-887-2552
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS98361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16573ZMedicare ID - Type Unspecified