Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW-010906-L | PA |
NPI | 1003197740 |
---|---|
Provider Name | Mr. Justin M Levitan |
First Address | Bryn Mawr, PA 19010-2133 |
Second Address | Bryn Mawr, PA 19010-2133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2011 |
Last Update Date | 08/09/2011 |