Provider Demographics
NPI:1013062967
Name:LEVINE, MICHELE Q (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:Q
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 HEMINGWAY CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5980
Mailing Address - Country:US
Mailing Address - Phone:860-212-4129
Mailing Address - Fax:860-667-6008
Practice Address - Street 1:100 MARKET SQ STE 10
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2921
Practice Address - Country:US
Practice Address - Phone:860-519-8571
Practice Address - Fax:860-667-6008
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health