Provider Demographics
NPI:1639342546
Name:LEVINE, BLAKE (CSW)
Entity type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146A MANETTO HILL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1323
Mailing Address - Country:US
Mailing Address - Phone:646-496-7183
Mailing Address - Fax:516-931-1745
Practice Address - Street 1:146A MANETTO HILL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1323
Practice Address - Country:US
Practice Address - Phone:646-496-7183
Practice Address - Fax:516-931-1745
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0717091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical