Provider Demographics
NPI:1760621536
Name:LEVIN, ROBERT S (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:S
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1280 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0026
Mailing Address - Country:US
Mailing Address - Phone:248-338-1050
Mailing Address - Fax:
Practice Address - Street 1:1280 EDISON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0026
Practice Address - Country:US
Practice Address - Phone:248-338-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001609101YM0800X
MI6801008434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health