Provider Demographics
NPI:1750400685
Name:AGIN LEVIN, RISA B (LCSW)
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:B
Last Name:AGIN LEVIN
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 1:336 W PASSAIC ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3027
Mailing Address - Country:US
Mailing Address - Phone:201-845-7030
Mailing Address - Fax:201-845-0899
Practice Address - Street 1:336 W PASSAIC ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3027
Practice Address - Country:US
Practice Address - Phone:201-845-7030
Practice Address - Fax:201-845-0899
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04902500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC04902500OtherNJ LCSW