Provider Demographics
NPI:1114064227
Name:LEVINE, JOEL BRADLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BRADLEY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2132
Mailing Address - Country:US
Mailing Address - Phone:516-349-7271
Mailing Address - Fax:516-349-9242
Practice Address - Street 1:40 MAIN PKWY
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2132
Practice Address - Country:US
Practice Address - Phone:516-349-7271
Practice Address - Fax:516-349-9242
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical