Provider Demographics
NPI:1972006344
Name:LEVINE, DAVID (MA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 W FORK RD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1944
Mailing Address - Country:US
Mailing Address - Phone:513-619-2961
Mailing Address - Fax:513-389-7523
Practice Address - Street 1:3030 W FORK RD BLDG 3
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1944
Practice Address - Country:US
Practice Address - Phone:513-619-2961
Practice Address - Fax:513-389-7523
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator