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General NPI Number Information
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NPI Number | 1629202916
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Entity Type | Individual
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Provider Name | MELANIE ETTAFAITH LEVINE LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 1190 W NORTHERN PKWY SUITE 110
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City | BALTIMORE
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State | MD
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Zip | 21210-1431
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Country | US
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Telephone | 410-218-7053
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Fax | 443-817-0844
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Provider Business Mailing Address
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Address Line | 1 EMERALD RIDGE CT
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City | BALTIMORE
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State | MD
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Zip | 21209-1560
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Country | US
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Telephone | 410-218-7053
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Fax | 443-817-0844
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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 | 11896
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License Number State | MD
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