Provider Demographics
NPI:1184806424
Name:LEVIN, THEODORE J (LCSW)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:J
Last Name:LEVIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 MCDANIEL DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6671
Mailing Address - Country:US
Mailing Address - Phone:610-692-6424
Mailing Address - Fax:610-692-4997
Practice Address - Street 1:1503 MCDANIEL DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6671
Practice Address - Country:US
Practice Address - Phone:610-692-6424
Practice Address - Fax:610-692-4997
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PACW0164931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)