Provider Demographics
NPI:1508897836
Name:LEVINE, BRUCE ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 475
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5531
Mailing Address - Country:US
Mailing Address - Phone:516-643-0400
Mailing Address - Fax:
Practice Address - Street 1:9107 WILSHIRE BLVD
Practice Address - Street 2:SUITE 475
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5531
Practice Address - Country:US
Practice Address - Phone:516-643-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004467103T00000X
CAPSY20225103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004467OtherNY LICENSE
CAPSY20225OtherCA LICENSE
106765500OtherUS DEPT OF LABOR