Healthcare Provider Details

I. General information

NPI: 1932031515
Provider Name (Legal Business Name): JACK ANTHONY LEVY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CYPRESS ST
MANCHESTER NH
03103-3628
US

IV. Provider business mailing address

2 WALL ST STE 200
MANCHESTER NH
03101-1518
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6084
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109936
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: