Provider Demographics
NPI:1306943923
Name:LEVINE, MANA LANG (MSW)
Entity type:Individual
Prefix:MRS
First Name:MANA
Middle Name:LANG
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:MANA
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:98 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2305
Mailing Address - Country:US
Mailing Address - Phone:973-744-8258
Mailing Address - Fax:
Practice Address - Street 1:98 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2305
Practice Address - Country:US
Practice Address - Phone:973-744-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002924001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ638892Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER