Provider Demographics
NPI:1124201983
Name:SUE LEVY PSYD LCSW PA
Entity Type:Organization
Organization Name:SUE LEVY PSYD LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LCSW
Authorized Official - Phone:386-253-8439
Mailing Address - Street 1:3959 S NOVA ROAD
Mailing Address - Street 2:BLDG B SUITE 23
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9229
Mailing Address - Country:US
Mailing Address - Phone:386-253-8439
Mailing Address - Fax:386-253-8579
Practice Address - Street 1:3959 S NOVA ROAD
Practice Address - Street 2:BLDG B SUITE 23
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9229
Practice Address - Country:US
Practice Address - Phone:386-253-8439
Practice Address - Fax:386-253-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00025131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1093747313OtherINDIVIDUAL NPI
FL768630700Medicaid
FL1093747313OtherINDIVIDUAL NPI
FLZ3751AMedicare PIN