Provider Demographics
NPI:1467463612
Name:LEV, BETH TABOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:TABOR
Last Name:LEV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:TABOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 OLD SOUTH ST
Mailing Address - Street 2:STE 1B
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3870
Mailing Address - Country:US
Mailing Address - Phone:413-585-5180
Mailing Address - Fax:
Practice Address - Street 1:13 OLD SOUTH ST
Practice Address - Street 2:STE 1B
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3870
Practice Address - Country:US
Practice Address - Phone:413-585-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1855930Medicaid
MA1855930Medicaid