Provider Demographics
NPI:1043824345
Name:LEVINE, SOPHIA GLENN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:GLENN
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 1:1330 1ST AVE APT 828
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4786
Mailing Address - Country:US
Mailing Address - Phone:914-907-3860
Mailing Address - Fax:
Practice Address - Street 1:1330 1ST AVE APT 828
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4786
Practice Address - Country:US
Practice Address - Phone:914-907-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106941104100000X
NY0946801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker