Provider Demographics
NPI:1295874857
Name:LEVIN, RONALD A (LCSW-C)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:LEVIN
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9053 SHADY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1301
Mailing Address - Country:US
Mailing Address - Phone:301-330-8832
Mailing Address - Fax:301-330-8832
Practice Address - Street 1:9053 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:301-330-8832
Practice Address - Fax:301-330-8832
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD021411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ378OtherMARYLAND BCBS
513788OtherNCPPO
001688OtherVALUE OPTIONS
A1180001OtherBCBS NATIONAL CAP AREA
513788OtherNCPPO