Provider Demographics
NPI:1275748170
Name:LEVENSON, JILL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:S
Last Name:LEVENSON
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 1:5950 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1238
Mailing Address - Country:US
Mailing Address - Phone:954-735-6240
Mailing Address - Fax:
Practice Address - Street 1:5950 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1238
Practice Address - Country:US
Practice Address - Phone:954-735-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 26591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical