Provider Demographics
NPI:1902568843
Name:LEVINE, CARLY ISABELLA
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ISABELLA
Last Name:LEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ROCKLAND ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-3436
Mailing Address - Country:US
Mailing Address - Phone:908-499-7903
Mailing Address - Fax:
Practice Address - Street 1:37 ROCKLAND ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-3436
Practice Address - Country:US
Practice Address - Phone:908-499-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78202235Z00000X
HISP-2057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist