Provider Demographics
NPI:1811928617
Name:LEVY, JEFFREY STEVEN (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:STEVEN
Last Name:LEVY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST STE 1300A
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3516
Mailing Address - Country:US
Mailing Address - Phone:207-284-1400
Mailing Address - Fax:207-284-1440
Practice Address - Street 1:110 MAIN ST STE 1300A
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3516
Practice Address - Country:US
Practice Address - Phone:207-284-1400
Practice Address - Fax:207-284-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9203Medicare ID - Type Unspecified