Provider Demographics
NPI:1780839779
Name:LEVITAN, BELLA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BELLA
Middle Name:
Last Name:LEVITAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CARLTON RD W
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4019
Mailing Address - Country:US
Mailing Address - Phone:845-357-0778
Mailing Address - Fax:
Practice Address - Street 1:102 CARLTON RD W
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4019
Practice Address - Country:US
Practice Address - Phone:845-357-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12121352OtherASHA ID #