Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 115769 | MA |
NPI | 1003098484 |
---|---|
Provider Name | Mr. Bradley Oliver Levy |
First Address | Dorchester, MA 02122-2932 |
Second Address | Boston, MA 02122-2932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 13/12/2011 |