Provider Demographics
NPI:1073636361
Name:LEVINSON, LAURIE JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:JANE
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E 72ND ST
Mailing Address - Street 2:APT. 14E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4683
Mailing Address - Country:US
Mailing Address - Phone:212-744-6653
Mailing Address - Fax:212-772-9116
Practice Address - Street 1:173 E 74TH ST
Practice Address - Street 2:APT. 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3219
Practice Address - Country:US
Practice Address - Phone:212-744-6653
Practice Address - Fax:212-772-9116
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009873-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist