Provider Demographics
NPI:1225265838
Name:LEVINE, JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:LEVINE
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 1:4833 DARROW RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1411
Mailing Address - Country:US
Mailing Address - Phone:330-650-5338
Mailing Address - Fax:330-342-3837
Practice Address - Street 1:4833 DARROW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1411
Practice Address - Country:US
Practice Address - Phone:330-650-5338
Practice Address - Fax:330-342-3837
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4760103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist