Provider Demographics
NPI:1710151295
Name:LEVY, CYNTHIA BURTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:BURTON
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 1:17 IRONGATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4616
Mailing Address - Country:US
Mailing Address - Phone:937-433-2053
Mailing Address - Fax:937-434-7546
Practice Address - Street 1:17 IRONGATE PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4616
Practice Address - Country:US
Practice Address - Phone:937-433-2053
Practice Address - Fax:937-434-7546
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLECP08052Medicare UPIN