Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW24340 | CA |
NPI | 1003061037 |
---|---|
Provider Name | Ms. Shoshana Levine |
First Address | Santa Monica, CA 90405-3063 |
Second Address | Santa Monica, CA 90405-3063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 18/11/2008 |