Provider Demographics
NPI:1609034677
Name:LEVY, CELINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CELINDA
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10805 TRANQUILO RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6939
Mailing Address - Country:US
Mailing Address - Phone:505-449-8396
Mailing Address - Fax:
Practice Address - Street 1:11024 MONTGOMERY BLVD NE
Practice Address - Street 2:POST MAILBOX 366
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3962
Practice Address - Country:US
Practice Address - Phone:505-449-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical