Provider Demographics
NPI:1700997954
Name:LEVINE, ADRIENNE IRIS (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:IRIS
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MRS
Other - First Name:IRIS
Other - Middle Name:ADRIENNE
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:24 SUTTON TERRACE
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753
Mailing Address - Country:US
Mailing Address - Phone:516-822-6090
Mailing Address - Fax:516-827-0859
Practice Address - Street 1:1025 NORTHERN BLVD
Practice Address - Street 2:STE 106
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576
Practice Address - Country:US
Practice Address - Phone:516-822-4543
Practice Address - Fax:516-827-0859
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06919711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q35463Medicare UPIN
NYN06B71Medicare ID - Type Unspecified