Basic Information
| Provider Information | |||||||||
| NPI: | 1528176534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | JAI | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 PINE GRV | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010022717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132566261 | ||||||||
| FaxNumber: | 4139679807 | ||||||||
| Practice Location | |||||||||
| Address1: | 664 A MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132566261 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1018341 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P06331 | 01 | MA | BCBS PROVIDER NUMBER | OTHER |