Provider Demographics
NPI:1124229356
Name:LEVINE, CYNTHIA (PSYD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:200 E 22ND ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3266
Mailing Address - Country:US
Mailing Address - Phone:360-953-2077
Mailing Address - Fax:360-696-4811
Practice Address - Street 1:200 E 22ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3266
Practice Address - Country:US
Practice Address - Phone:360-953-2077
Practice Address - Fax:360-696-4811
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007798101YM0800X
ORC1473101YP2500X
WAPY 60049102103TC0700X, 103TC2200X, 103TF0000X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth