Provider Demographics
NPI:1073535431
Name:LEVINE, ROBERT BARRY (MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BARRY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 2700-79
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1901
Mailing Address - Country:US
Mailing Address - Phone:310-840-2019
Mailing Address - Fax:
Practice Address - Street 1:3435 WILSHIRE BLVD
Practice Address - Street 2:SUITE 2700-79
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1901
Practice Address - Country:US
Practice Address - Phone:310-840-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist