Provider Demographics
NPI:1962673509
Name:LEVINE, JENNIFER B (LCMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8123
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:VT
Mailing Address - Zip Code:05451-8123
Mailing Address - Country:US
Mailing Address - Phone:802-316-8855
Mailing Address - Fax:
Practice Address - Street 1:15 PINECREST DR UNIT 3
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-2936
Practice Address - Country:US
Practice Address - Phone:802-316-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health