Provider Demographics
NPI:1609929330
Name:LEVIN, GLORIA ANN BURGESS (PSYD LP)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ANN BURGESS
Last Name:LEVIN
Suffix:
Gender:F
Credentials:PSYD LP
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Mailing Address - Street 1:1201 YALE PL
Mailing Address - Street 2:#1209
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1901
Mailing Address - Country:US
Mailing Address - Phone:612-332-4309
Mailing Address - Fax:612-349-4616
Practice Address - Street 1:1409 WILLOW STREET
Practice Address - Street 2:#610
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1955
Practice Address - Country:US
Practice Address - Phone:612-871-2522
Practice Address - Fax:612-349-4616
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP4100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist