Provider Demographics
NPI:1295038446
Name:LEVINE, CHRISTINE NOELLE (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NOELLE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SCHOOL ST.
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026
Mailing Address - Country:US
Mailing Address - Phone:860-413-9538
Mailing Address - Fax:860-838-4241
Practice Address - Street 1:15 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026
Practice Address - Country:US
Practice Address - Phone:860-413-9538
Practice Address - Fax:860-838-4241
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-04-1525103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst