Provider Demographics
NPI:1265466841
Name:LEVIN, M. PENNY (PHD)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:PENNY
Last Name:LEVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PEAR TREE LANE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444
Mailing Address - Country:US
Mailing Address - Phone:610-825-7470
Mailing Address - Fax:215-640-0600
Practice Address - Street 1:14 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2302
Practice Address - Country:US
Practice Address - Phone:610-825-7470
Practice Address - Fax:215-640-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical