Provider Demographics
NPI:1164588208
Name:LEVINE, JENNIFER (PSYD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 KANAN RD STE 157
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3358
Mailing Address - Country:US
Mailing Address - Phone:310-499-7070
Mailing Address - Fax:810-815-7070
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:SUITE 1033
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2601
Practice Address - Country:US
Practice Address - Phone:310-499-7070
Practice Address - Fax:810-815-7070
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20579103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical