Provider Demographics
NPI:1285850032
Name:LEVIN, SUSAN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
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 1:2200 NW CORPORATE BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7387
Mailing Address - Country:US
Mailing Address - Phone:561-417-0220
Mailing Address - Fax:561-807-6807
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:STE 205A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3458
Practice Address - Country:US
Practice Address - Phone:561-417-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54091Medicare ID - Type Unspecified