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General NPI Number Information
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NPI Number | 1770992695
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Entity Type | Individual
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Provider Name | JACQUELINE B. LEVIN LMFT, MS, MA
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Gender | Female
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 639 PROSPECT AVE 3RD FLOOR
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City | WEST HARTFORD
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State | CT
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Zip | 06105-4276
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Country | US
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Telephone | 860-385-1574
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Fax | 860-561-0278
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Provider Business Mailing Address
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Address Line | 639 PROSPECT AVE 3RD FLOOR
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City | WEST HARTFORD
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State | CT
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Zip | 06105-4276
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Country | US
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Telephone | 860-385-1574
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Fax | 860-561-0278
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | CT
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