Provider Demographics
NPI:1134296346
Name:LEVITAN, AMY (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LEVITAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1416
Mailing Address - Country:US
Mailing Address - Phone:781-856-4718
Mailing Address - Fax:
Practice Address - Street 1:1 MAGUIRE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-3114
Practice Address - Country:US
Practice Address - Phone:781-784-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10247291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical