Provider Demographics
NPI:1235173105
Name:LEVIN, DANIEL NEAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NEAL
Last Name:LEVIN
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 1:3614 JOHN MUIR DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5138
Mailing Address - Country:US
Mailing Address - Phone:608-203-5015
Mailing Address - Fax:
Practice Address - Street 1:2727 MARSHALL CT
Practice Address - Street 2:PSSC
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2255
Practice Address - Country:US
Practice Address - Phone:608-238-9354
Practice Address - Fax:608-238-7675
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1064-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1064-057OtherCLINICAL PSYCHOLOGY LICEN