Provider Demographics
NPI:1376131698
Name:SHIRAZ LEVKOVICH PSY D INC
Entity Type:Organization
Organization Name:SHIRAZ LEVKOVICH PSY D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-758-9866
Mailing Address - Street 1:300 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4414
Mailing Address - Country:US
Mailing Address - Phone:617-758-9866
Mailing Address - Fax:
Practice Address - Street 1:1170 BEACON ST STE 301
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3963
Practice Address - Country:US
Practice Address - Phone:617-249-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)