Provider Demographics
NPI:1790847697
Name:LEVY, RONA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:RONA
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 W MARCH LN STE D200
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6670
Mailing Address - Country:US
Mailing Address - Phone:209-951-3322
Mailing Address - Fax:209-951-0448
Practice Address - Street 1:2291 W MARCH LN STE D200
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6670
Practice Address - Country:US
Practice Address - Phone:209-951-3322
Practice Address - Fax:209-951-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT21038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist