=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366265225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WYNNE LEVINE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2024
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 CONIFER HILL DR UNIT 104
-----------------------------------------------------
City | DANVERS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01923-1198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 351-232-2015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 191 BEACH RD UNIT D204
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01952-2292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-475-7551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW2121176
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------