Doctor Name: | MR. JACK BRIAN LEVIN |
NPI Number: | 1083999338 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LICSW |
License Number: | 118144 |
Business Practice Address: | 800 W Cummings Park Suite 3000 Woburn, MA - 018016372 |
Business Phone Number: | 6174174535 |
Business Fax Number: | |
Mailing Address: | 23 Leach St, SALEM |
State: | MA |
Postal Code: | 019704710 |
Phone Number: | 6174174535 |
Fax Number: | |
NPI Enumeration Date: | 10/19/2011 |
NPI Last Update Date: | 08/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 118144 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |