Provider Demographics
NPI:1154055614
Name:LEVEAUX, ANNA MARIA B
Entity Type:Individual
Prefix:
First Name:ANNA MARIA
Middle Name:B
Last Name:LEVEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41535
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90853-1535
Mailing Address - Country:US
Mailing Address - Phone:310-213-8278
Mailing Address - Fax:
Practice Address - Street 1:2772 E 2ND ST UNIT 1E
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5157
Practice Address - Country:US
Practice Address - Phone:310-213-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical