Provider Demographics
NPI:1982614913
Name:LEVINE, SUSAN F (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
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 1:238 MAIN ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3243
Mailing Address - Country:US
Mailing Address - Phone:413-774-6252
Mailing Address - Fax:
Practice Address - Street 1:238 MAIN ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3243
Practice Address - Country:US
Practice Address - Phone:413-774-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10276791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20660Medicare ID - Type Unspecified