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General NPI Number Information
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NPI Number | 1548212442
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Entity Type | Individual
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Provider Name | SUSAN L LEVINE LCSW, LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 116 VILLAGE BLVD
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City | PRINCETON
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State | NJ
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Zip | 08540-5700
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Country | US
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Telephone | 732-718-3704
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Fax | 732-718-3704
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Provider Business Mailing Address
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Address Line | 92 DELAWARE AVE
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City | METUCHEN
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State | NJ
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Zip | 08840-2438
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Country | US
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Telephone | 732-718-3704
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Fax | 732-718-3704
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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 | 44SC01338200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37FI00109900
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License Number State | NJ
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