Provider Demographics
NPI:1053534867
Name:LEVINE, ELISSA (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:ELISSA
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17003 BARN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1107
Mailing Address - Country:US
Mailing Address - Phone:240-462-7659
Mailing Address - Fax:
Practice Address - Street 1:17003 BARN RIDGE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1107
Practice Address - Country:US
Practice Address - Phone:240-462-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical