Provider Demographics
NPI:1003590852
Name:LEVIN, ILANA H (PSYD)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:H
Last Name:LEVIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 OLD LANCASTER RD APT 101
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1753
Mailing Address - Country:US
Mailing Address - Phone:443-610-0400
Mailing Address - Fax:
Practice Address - Street 1:1221 LOCUST ST STE 204
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5570
Practice Address - Country:US
Practice Address - Phone:215-668-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist