Provider Demographics
NPI:1326145442
Name:CYNTHIA B LEVY PHD
Entity Type:Organization
Organization Name:CYNTHIA B LEVY PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:937-390-7712
Mailing Address - Street 1:2207 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2736
Mailing Address - Country:US
Mailing Address - Phone:937-390-7712
Mailing Address - Fax:937-390-8765
Practice Address - Street 1:2207 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2736
Practice Address - Country:US
Practice Address - Phone:937-390-7712
Practice Address - Fax:937-390-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0512350Medicaid
OHLECP08052Medicare UPIN
OH0512350Medicaid