Provider Demographics
NPI:1194964577
Name:LEVINE, RORY BLAIR (MSW)
Entity type:Individual
Prefix:MRS
First Name:RORY
Middle Name:BLAIR
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 NE 195TH ST
Mailing Address - Street 2:# 419
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3340
Mailing Address - Country:US
Mailing Address - Phone:305-992-4983
Mailing Address - Fax:
Practice Address - Street 1:671 NE 195TH ST
Practice Address - Street 2:# 419
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3340
Practice Address - Country:US
Practice Address - Phone:305-992-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW85601041C0700X
FLCAP 4906101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)