Provider Demographics
NPI:1538107123
Name:LAWRENCE J. LEVY, PSY.D., P.A.
Entity Type:Organization
Organization Name:LAWRENCE J. LEVY, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-210-5125
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33429-0720
Mailing Address - Country:US
Mailing Address - Phone:561-210-5125
Mailing Address - Fax:561-210-8802
Practice Address - Street 1:398 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5827
Practice Address - Country:US
Practice Address - Phone:561-210-5125
Practice Address - Fax:561-210-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9575Medicare PIN