Provider Demographics
NPI:1073660734
Name:LEVINE, BRUCE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:LEVINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:E
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5725 DRAGON WAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-4593
Mailing Address - Country:US
Mailing Address - Phone:513-271-1777
Mailing Address - Fax:
Practice Address - Street 1:5725 DRAGON WAY
Practice Address - Street 2:SUITE 303
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-4593
Practice Address - Country:US
Practice Address - Phone:513-271-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical