Provider Demographics
NPI:1386110476
Name:LEVINE, TANDY LAURIE (LCSW)
Entity type:Individual
Prefix:
First Name:TANDY
Middle Name:LAURIE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 CONNECTICUT AVE NW STE 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5709
Mailing Address - Country:US
Mailing Address - Phone:202-255-0985
Mailing Address - Fax:
Practice Address - Street 1:1808 CONNECTICUT AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5709
Practice Address - Country:US
Practice Address - Phone:202-255-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3003161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical