Provider Demographics
NPI:1013515808
Name:DE JESUS LEVY, DORIS MARIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:MARIA
Last Name:DE JESUS LEVY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 E 23RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07513-1477
Mailing Address - Country:US
Mailing Address - Phone:201-486-6303
Mailing Address - Fax:
Practice Address - Street 1:862 E 23RD ST APT 2
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07513-1477
Practice Address - Country:US
Practice Address - Phone:201-486-6303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055970001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty