Provider Demographics
NPI:1124483144
Name:LEVENSON HAMBY, JERRI ANN (LCSW)
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:ANN
Last Name:LEVENSON HAMBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JERRI
Other - Middle Name:ANN
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-2545
Mailing Address - Country:US
Mailing Address - Phone:860-908-4889
Mailing Address - Fax:
Practice Address - Street 1:132 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2027
Practice Address - Country:US
Practice Address - Phone:860-456-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical