MEDICARE: MS. LOIS LEVINSKY 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	1041C0700X	Clinical Social Worker	LICSW 102359	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LE P01083	OTHER	MA	BCBSMA

General Provider Information

NPI Number	:	1134115496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOIS LEVINSKY LICSW

Provider Business Mailing Address
First Line	:	8 EASTMAN RD
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1306
Country	:	US
Telephone Number	:	617-666-2039
Fax Number	:	617-666-6773

Provider Business Practice Location Address
First Line	:	8 EASTMAN RD
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1306
Country	:	US
Telephone Number	:	617-666-2039
Fax Number	:	617-666-6773

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/08/2007

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