Provider Demographics
NPI:1720237118
Name:LEVINE, DAVID M (MFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:UPSTAIRS
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2920
Mailing Address - Country:US
Mailing Address - Phone:631-456-3601
Mailing Address - Fax:
Practice Address - Street 1:38 PENATAQUIT PL
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2415
Practice Address - Country:US
Practice Address - Phone:631-423-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000629106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist