Healthcare Provider Details

I. General information

NPI: 1790700235
Provider Name (Legal Business Name): MARCIA LEVINE M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHITTENDEN REGIONAL CORRECTIONAL FACILITY 7 FARRELL STREET
SOUTH BURLINGTON VT
05403
US

IV. Provider business mailing address

31 FOREST ST
WINOOSKI VT
05404-1905
US

V. Phone/Fax

Practice location:
  • Phone: 802-859-3213
  • Fax:
Mailing address:
  • Phone: 802-655-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0890001000
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: