Provider Demographics
NPI:1508959065
Name:LEVIN, MERYL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MERYL
Middle Name:A
Last Name:LEVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:390 MASSACHUSETTS AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474
Mailing Address - Country:US
Mailing Address - Phone:781-648-4247
Mailing Address - Fax:
Practice Address - Street 1:390 MASSACHUSETTS AVE
Practice Address - Street 2:STE 4
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474
Practice Address - Country:US
Practice Address - Phone:781-648-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7673103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2241602OtherFIRST HEALTH/CCN
MA360526OtherTUFTS HEALTH PLAN
MA792896000OtherMAGELLAN BEHAVIORAL HEALT
MAW06115OtherBLUE CROSS BLUE SHIELD MA
MAW06115OtherBLUE CROSS BLUE SHIELD MA