Provider Demographics
NPI:1598882631
Name:LEVIN, DANIEL (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
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 1:8515 DELMAR BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2168
Mailing Address - Country:US
Mailing Address - Phone:314-567-1044
Mailing Address - Fax:314-567-1060
Practice Address - Street 1:8515 DELMAR BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2168
Practice Address - Country:US
Practice Address - Phone:314-567-1044
Practice Address - Fax:314-567-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical