MEDICARE: SUSAN MARSHA LEVINE 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	104100000X	Social Worker	105468	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TX4743	OTHER	MA	MEDICARE PTAN

General Provider Information

NPI Number	:	1073541884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARSHA LEVINE LICSW

Provider Business Mailing Address
First Line	:	362 N BEDFORD ST
Second Line	:
City	:	EAST BRIDGEWATER
State	:	MA
Zip	:	02333-1148
Country	:	US
Telephone Number	:	508-350-2450
Fax Number	:	508-350-2318

Provider Business Practice Location Address
First Line	:	175 N FRANKLIN ST
Second Line	:
City	:	HOLBROOK
State	:	MA
Zip	:	02343
Country	:	US
Telephone Number	:	781-767-5552
Fax Number	:	781-986-8752

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	03/10/2011

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