Provider Demographics
NPI:1821165929
Name:LEVY, RICHARD MICHAEL (MSW NY LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:LEVY
Suffix:
Gender:M
Credentials:MSW NY LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 WESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1541
Mailing Address - Country:US
Mailing Address - Phone:631-757-3772
Mailing Address - Fax:631-757-5060
Practice Address - Street 1:410 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1541
Practice Address - Country:US
Practice Address - Phone:631-757-5555
Practice Address - Fax:631-757-5060
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013564104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical