Healthcare Provider Details

I. General information

NPI: 1700794914
Provider Name (Legal Business Name): MDL LIFE TRANSFORMATION GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WATER ST APT 615
BROOKLYN NY
11201-1974
US

IV. Provider business mailing address

60 WATER ST APT 615
BROOKLYN NY
11201-1974
US

V. Phone/Fax

Practice location:
  • Phone: 267-949-7406
  • Fax:
Mailing address:
  • Phone: 267-949-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE DAVIS-LEVY
Title or Position: OWNER
Credential: LCSW
Phone: 267-949-7406