Provider Demographics
NPI:1245367796
Name:LEVIN, JAY M (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:LEVIN
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:ADELPHIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07710-0013
Mailing Address - Country:US
Mailing Address - Phone:732-492-9132
Mailing Address - Fax:732-303-5969
Practice Address - Street 1:495 IRON BRIDGE RD STE 8
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5306
Practice Address - Country:US
Practice Address - Phone:732-492-9132
Practice Address - Fax:732-303-5969
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045245001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ787447Medicare ID - Type Unspecified