Provider Demographics
NPI:1346368438
Name:LEVINE, ROSLYN S (PHD)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:S
Last Name:LEVINE
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 1:33 OLD TOWN LN
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2214
Mailing Address - Country:US
Mailing Address - Phone:631-673-2862
Mailing Address - Fax:
Practice Address - Street 1:33 OLD TOWN LN
Practice Address - Street 2:
Practice Address - City:HALESITE
Practice Address - State:NY
Practice Address - Zip Code:11743-2214
Practice Address - Country:US
Practice Address - Phone:631-673-2862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0073411103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
145466OtherVALUE OPTIONS
0007357250OtherAETNA PIN
0088733OtherGHI
NYV72584Medicare UPIN