Provider Demographics
NPI:1740315258
Name:LEVINE, JANET H (LICSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:H
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1423
Mailing Address - Country:US
Mailing Address - Phone:413-665-1300
Mailing Address - Fax:413-665-3477
Practice Address - Street 1:250 GREENFIELD ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9790
Practice Address - Country:US
Practice Address - Phone:413-665-1300
Practice Address - Fax:413-665-3477
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10209201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22255Medicare ID - Type Unspecified