Provider Demographics
NPI:1598068777
Name:LEVIN, SUSAN ELIZABETH (PSYD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:LEVIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 MINERAL POINT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1623
Mailing Address - Country:US
Mailing Address - Phone:608-833-9290
Mailing Address - Fax:608-833-9691
Practice Address - Street 1:7617 MINERAL POINT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1623
Practice Address - Country:US
Practice Address - Phone:608-833-9290
Practice Address - Fax:608-833-9691
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2908-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical