Provider Demographics
NPI:1407035397
Name:LEVY, JUDITH RENEE (LCAT, MFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:RENEE
Last Name:LEVY
Suffix:
Gender:F
Credentials:LCAT, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 72ND ST
Mailing Address - Street 2:APT #4E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4650
Mailing Address - Country:US
Mailing Address - Phone:212-388-9447
Mailing Address - Fax:
Practice Address - Street 1:420 E 72ND ST
Practice Address - Street 2:APT #4E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4650
Practice Address - Country:US
Practice Address - Phone:212-388-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27323106H00000X
NYLCAT001003174400000X
NY000755-1106H00000X
NY000838-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst