Provider Demographics
NPI:1770992695
Name:LEVIN, JACQUELINE B (LMFT, MS, MA)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:B
Last Name:LEVIN
Suffix:
Gender:F
Credentials:LMFT, MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 PROSPECT AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4276
Mailing Address - Country:US
Mailing Address - Phone:860-385-1574
Mailing Address - Fax:860-561-0278
Practice Address - Street 1:639 PROSPECT AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4276
Practice Address - Country:US
Practice Address - Phone:860-385-1574
Practice Address - Fax:860-561-0278
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist