Provider Demographics
NPI:1639359730
Name:LEVIN, LENORE MARSHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LENORE
Middle Name:MARSHA
Last Name:LEVIN
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 1:14429 SEABRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4225
Mailing Address - Country:US
Mailing Address - Phone:858-675-0670
Mailing Address - Fax:
Practice Address - Street 1:14429 SEABRIDGE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4225
Practice Address - Country:US
Practice Address - Phone:858-675-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY0303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical