MEDICARE: JUSTIN CHARLES LEVY LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	32300	MN

General Provider Information

NPI Number	:	1063381028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN CHARLES LEVY LICSW

Provider Business Mailing Address
First Line	:	2900 11TH AVE S APT 208
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-5814
Country	:	US
Telephone Number	:	612-202-9552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612C W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2549
Country	:	US
Telephone Number	:	612-202-9552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	10/30/2025

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Directions to “ JUSTIN CHARLES LEVY LICSW” Practice Location

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