Healthcare Provider Details

I. General information

NPI: 1972626760
Provider Name (Legal Business Name): LAURA E LEVINE MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 PARK AVE
CRANSTON RI
02910-3225
US

IV. Provider business mailing address

252 4TH ST
PROVIDENCE RI
02906-3754
US

V. Phone/Fax

Practice location:
  • Phone: 401-275-5039
  • Fax: 401-946-9340
Mailing address:
  • Phone: 401-383-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCPC00214
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00136
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: