1770992695 NPI number — MISS JACQUELINE B. LEVIN LMFT, MS, MA

Table of content: MISS JACQUELINE B. LEVIN LMFT, MS, MA (NPI 1770992695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770992695 NPI number — MISS JACQUELINE B. LEVIN LMFT, MS, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVIN
Provider First Name:
JACQUELINE
Provider Middle Name:
B.
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMFT, MS, MA
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:
1770992695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
639 PROSPECT AVE
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-4276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-385-1574
Provider Business Mailing Address Fax Number:
860-561-0278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
639 PROSPECT AVE
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
WEST HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-4276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-385-1574
Provider Business Practice Location Address Fax Number:
860-561-0278
Provider Enumeration Date:
08/05/2014

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: 106H00000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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