1033275680 NPI number — MS. SUSAN RAE LEVIN MSW

Table of content: MS. SUSAN RAE LEVIN MSW (NPI 1033275680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033275680 NPI number — MS. SUSAN RAE LEVIN MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVIN
Provider First Name:
SUSAN
Provider Middle Name:
RAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033275680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 PERKINS ST
Provider Second Line Business Mailing Address:
E102
Provider Business Mailing Address City Name:
JAMAICA PLAIN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02130-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-969-6373
Provider Business Mailing Address Fax Number:
617-969-0596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 LANGLEY RD
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
NEWTON CENTRE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02459-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-969-6373
Provider Business Practice Location Address Fax Number:
617-969-0596
Provider Enumeration Date:
12/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  103242 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)