Provider Demographics
NPI:1528389616
Name:LEVENBERG, KAREN RENA (EDD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:RENA
Last Name:LEVENBERG
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2302
Mailing Address - Country:US
Mailing Address - Phone:973-379-7916
Mailing Address - Fax:973-379-7916
Practice Address - Street 1:37 COTTAGE LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2302
Practice Address - Country:US
Practice Address - Phone:973-379-7916
Practice Address - Fax:973-379-7916
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00315600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ036498Medicare PIN