Healthcare Provider Details

I. General information

NPI: 1922235720
Provider Name (Legal Business Name): LAUREL LEVIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 ROUTE 111 SUITE 103
SMITHTOWN NY
11787-4756
US

IV. Provider business mailing address

363 ROUTE 111 SUITE 103
SMITHTOWN NY
11787-4756
US

V. Phone/Fax

Practice location:
  • Phone: 631-335-3960
  • Fax: 631-335-3960
Mailing address:
  • Phone: 631-335-3960
  • Fax: 631-335-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079890-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: