Provider Demographics
NPI:1023790326
Name:LEVINE, MAREN LEAH (LMSW)
Entity type:Individual
Prefix:
First Name:MAREN
Middle Name:LEAH
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MAREN
Other - Middle Name:LEAH
Other - Last Name:HEFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13554 ARROYO DALE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5789
Mailing Address - Country:US
Mailing Address - Phone:917-993-0402
Mailing Address - Fax:
Practice Address - Street 1:13554 ARROYO DALE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-5789
Practice Address - Country:US
Practice Address - Phone:917-993-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health