Provider Demographics
NPI:1326184466
Name:LEVINSON, ERIC JOHN (MSW)
Entity type:Individual
Prefix:MR
First Name:ERIC JOHN
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LEDGE DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2241
Mailing Address - Country:US
Mailing Address - Phone:516-761-5099
Mailing Address - Fax:
Practice Address - Street 1:31 BAYSIDE AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2717
Practice Address - Country:US
Practice Address - Phone:516-761-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0135601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN42401Medicare UPIN