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General NPI Number Information
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NPI Number | 1407925464
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Entity Type | Individual
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Provider Name | SUSAN A. LEVINE LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 8097 ROSWELL RD BLDG B
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City | ATLANTA
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State | GA
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Zip | 30350-6159
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Country | US
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Telephone | 770-393-8806
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Fax | 770-393-8812
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Provider Business Mailing Address
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Address Line | 8097 ROSWELL RD BLDG B
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City | ATLANTA
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State | GA
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Zip | 30350-6159
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Country | US
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Telephone | 770-393-8806
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Fax | 770-393-8812
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 000349
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License Number State | GA
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