Provider Demographics
NPI:1750430898
Name:LEVITT, MARILYN SANDRA (MSW-LICSW, LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:SANDRA
Last Name:LEVITT
Suffix:
Gender:F
Credentials:MSW-LICSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SAINT STEPHEN ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-4503
Mailing Address - Country:US
Mailing Address - Phone:617-266-8212
Mailing Address - Fax:617-421-1572
Practice Address - Street 1:39 SAINT STEPHEN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-4503
Practice Address - Country:US
Practice Address - Phone:617-266-8212
Practice Address - Fax:617-421-1572
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1071961041C0700X
MA162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALEP21921Medicare ID - Type Unspecified