Provider Demographics
NPI:1760620090
Name:LEVIN, LISA A (LCSW, BCD, CAS, CECP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:LEVIN
Suffix:
Gender:F
Credentials:LCSW, BCD, CAS, CECP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 MIAMI ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-1336
Mailing Address - Country:US
Mailing Address - Phone:574-313-1374
Mailing Address - Fax:574-537-2652
Practice Address - Street 1:2314 MIAMI STREET
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-1336
Practice Address - Country:US
Practice Address - Phone:574-313-1374
Practice Address - Fax:574-537-2652
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003654104100000X
IN34005742A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker