Provider Demographics
NPI:1407001191
Name:LEVINE, JACQUELINE ZELLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ZELLER
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 1:106 CALLE PAULA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5707
Mailing Address - Country:US
Mailing Address - Phone:505-989-1545
Mailing Address - Fax:505-989-1545
Practice Address - Street 1:106 CALLE PAULA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5707
Practice Address - Country:US
Practice Address - Phone:505-989-1545
Practice Address - Fax:505-989-1545
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0787101YM0800X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst