Provider Demographics
NPI:1700814258
Name:LEVY, FREDERICK ALAN (MSW)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:ALAN
Last Name:LEVY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 702
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4218
Mailing Address - Country:US
Mailing Address - Phone:757-873-1240
Mailing Address - Fax:757-873-4915
Practice Address - Street 1:732 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 702
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4218
Practice Address - Country:US
Practice Address - Phone:757-873-1240
Practice Address - Fax:757-873-4915
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040009431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R6012Medicare UPIN
VA800002828Medicare ID - Type Unspecified