Healthcare Provider Details

I. General information

NPI: 1669928958
Provider Name (Legal Business Name): JULIA FAY LEVINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date: 01/13/2020
Reactivation Date: 03/18/2020

III. Provider practice location address

75 BICKFORD ST
JAMAICA PLAIN MA
02130-1401
US

IV. Provider business mailing address

306 WASHINGTON ST. DANA GROUP ASSOCIATES.
NORWELL MA
02061
US

V. Phone/Fax

Practice location:
  • Phone: 617-971-2100
  • Fax:
Mailing address:
  • Phone: 617-971-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000225048
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number513372
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: