Provider Demographics
NPI:1801041603
Name:LEVY, LAUREN DALE (LMSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DALE
Last Name:LEVY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 BRAGG ST
Mailing Address - Street 2:APT. 3F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2171 BRAGG ST
Practice Address - Street 2:APT. 3F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5142
Practice Address - Country:US
Practice Address - Phone:917-613-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063373-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker