Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003208372 |
---|---|
Provider Name | Michael Levi |
First Address | Lexington, MA 02421-4903 |
Second Address | Lexington, MA 02421-4903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2015 |
Last Update Date | 28/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110026265E | (05) | MA |