Provider Demographics
NPI:1336610872
Name:LEVINE, JAYNE NICOLE (LMHC)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:NICOLE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 S OCEAN BLVD APT 1002
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33487-4228
Mailing Address - Country:US
Mailing Address - Phone:561-271-0153
Mailing Address - Fax:
Practice Address - Street 1:4505 S OCEAN BLVD APT 1002
Practice Address - Street 2:
Practice Address - City:HIGHLAND BEACH
Practice Address - State:FL
Practice Address - Zip Code:33487-4228
Practice Address - Country:US
Practice Address - Phone:561-271-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH3868OtherLMHC