Provider Demographics
NPI:1134179120
Name:LEVINE, JOAN LYNNE (LISW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:LYNNE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 OVERLOOK DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1881
Mailing Address - Country:US
Mailing Address - Phone:505-831-2591
Mailing Address - Fax:505-831-2591
Practice Address - Street 1:5516 OVERLOOK DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1881
Practice Address - Country:US
Practice Address - Phone:505-831-2591
Practice Address - Fax:505-831-2591
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-060701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17859255Medicaid
NM333718601Medicare PIN