Provider Demographics
NPI:1871771600
Name:LEVY-RUBINSTEIN, DIANE (MSW/LMSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LEVY-RUBINSTEIN
Suffix:
Gender:F
Credentials:MSW/LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 LEYTONSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1237
Mailing Address - Country:US
Mailing Address - Phone:248-285-1479
Mailing Address - Fax:
Practice Address - Street 1:6455 LEYTONSTONE BLVD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1237
Practice Address - Country:US
Practice Address - Phone:248-285-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010151871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN51270038Medicare PIN