MEDICARE: MR. THEODORE J LEVIN LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker	CW016493	PA

General Provider Information

NPI Number	:	1184806424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE J LEVIN LCSW

Provider Business Mailing Address
First Line	:	1503 MCDANIEL DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-6671
Country	:	US
Telephone Number	:	610-692-6424
Fax Number	:	610-692-4997

Provider Business Practice Location Address
First Line	:	1503 MCDANIEL DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-6671
Country	:	US
Telephone Number	:	610-692-6424
Fax Number	:	610-692-4997

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

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	02/24/2010

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