Provider Demographics
NPI:1578593661
Name:LEVIN, STEPHEN RONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RONALD
Last Name:LEVIN
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 1:5100 N OCEAN BLVD
Mailing Address - Street 2:#1013
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3036
Mailing Address - Country:US
Mailing Address - Phone:954-709-7843
Mailing Address - Fax:
Practice Address - Street 1:5100 N OCEAN BLVD
Practice Address - Street 2:#1013
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-3036
Practice Address - Country:US
Practice Address - Phone:954-709-7843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5941103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist