Provider Demographics
NPI:1831137785
Name:LEVENSON, RICHARD L JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:LEVENSON
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E 50TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-7504
Mailing Address - Country:US
Mailing Address - Phone:212-860-1473
Mailing Address - Fax:212-860-1473
Practice Address - Street 1:135 E 50TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-7504
Practice Address - Country:US
Practice Address - Phone:212-860-1473
Practice Address - Fax:212-860-1473
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV61891Medicare UPIN