Provider Demographics
NPI:1740342351
Name:LEVINE, JUDITH (LICSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
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 1:175 DERBY ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4007
Mailing Address - Country:US
Mailing Address - Phone:781-749-9227
Mailing Address - Fax:781-740-0233
Practice Address - Street 1:175 DERBY ST
Practice Address - Street 2:UNIT 2
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4007
Practice Address - Country:US
Practice Address - Phone:781-749-9227
Practice Address - Fax:781-740-0233
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1029891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical