Provider Demographics
NPI:1760569081
Name:LEVINE, BONNIE SUE (SW CLINICAL LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SUE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:SW CLINICAL LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1033
Mailing Address - Country:US
Mailing Address - Phone:516-935-6858
Mailing Address - Fax:516-935-2717
Practice Address - Street 1:385 W JOHN ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1033
Practice Address - Country:US
Practice Address - Phone:516-935-6858
Practice Address - Fax:516-935-2717
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0702041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical