Provider Demographics
NPI:1164546834
Name:LEVINSON, JAY I (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:I
Last Name:LEVINSON
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 1:2360 W JOPPA RD STE 318
Mailing Address - Street 2:GREENSPRING STATION
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4639
Mailing Address - Country:US
Mailing Address - Phone:410-825-3646
Mailing Address - Fax:410-825-3649
Practice Address - Street 1:2360 W JOPPA RD STE 318
Practice Address - Street 2:GREENSPRING STATION
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4639
Practice Address - Country:US
Practice Address - Phone:410-825-3646
Practice Address - Fax:410-825-3649
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1336103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKF26OtherCAREFIRST BCBS
MDW240OtherCAREFIRST BCBS
MDW240OtherCAREFIRST BCBS