Provider Demographics
NPI:1972626760
Name:LEVINE, LAURA E (MHC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:E
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3754
Mailing Address - Country:US
Mailing Address - Phone:401-383-0395
Mailing Address - Fax:
Practice Address - Street 1:1052 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3225
Practice Address - Country:US
Practice Address - Phone:401-275-5039
Practice Address - Fax:401-946-9340
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00136101YM0800X
RICPC00214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)