Provider Demographics
NPI:1679799738
Name:LEVY, MARY ANN
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:CHUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1660 S ALBION ST
Mailing Address - Street 2:SUITE 903
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4008
Mailing Address - Country:US
Mailing Address - Phone:303-329-8312
Mailing Address - Fax:303-279-9552
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:SUITE 903
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4008
Practice Address - Country:US
Practice Address - Phone:303-329-8312
Practice Address - Fax:303-279-9552
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18022102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53281OtherSTATE PROVIDER NUMBER