Provider Demographics
NPI:1699119305
Name:LEVY, PATRICE MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:MICHELE
Last Name:LEVY
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 1:93 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1723
Mailing Address - Country:US
Mailing Address - Phone:234-421-1725
Mailing Address - Fax:
Practice Address - Street 1:93 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1723
Practice Address - Country:US
Practice Address - Phone:234-421-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27774101YA0400X
NY104100000X, 1041S0200X
COCSW.099289561041C0700X
NY0844621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06540376Medicaid