Provider Demographics
NPI:1821212036
Name:LEVINE, BARRY JAY (LISW)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:JAY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 BENJAMIN CT SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1205
Mailing Address - Country:US
Mailing Address - Phone:505-934-2160
Mailing Address - Fax:505-892-2804
Practice Address - Street 1:912 BENJAMIN CT SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1205
Practice Address - Country:US
Practice Address - Phone:505-934-2160
Practice Address - Fax:505-892-2804
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-28871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical