Provider Demographics
NPI:1760543953
Name:LEVINE, MELANI (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MELANI
Middle Name:
Last Name:LEVINE
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 1:460 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3582
Mailing Address - Country:US
Mailing Address - Phone:917-881-1959
Mailing Address - Fax:973-783-6500
Practice Address - Street 1:460 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3582
Practice Address - Country:US
Practice Address - Phone:917-881-1959
Practice Address - Fax:973-783-6500
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066052-1104100000X
NJ44SC054359001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker