Provider Demographics
NPI:1619208774
Name:LEVY, WENDY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:LEVY
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 1:31 IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4303
Mailing Address - Country:US
Mailing Address - Phone:203-221-8377
Mailing Address - Fax:203-226-8967
Practice Address - Street 1:31 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4303
Practice Address - Country:US
Practice Address - Phone:203-221-8377
Practice Address - Fax:203-226-8967
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical