Provider Demographics
NPI:1831662774
Name:LEVKOVICH, SHIRAZ (PSYD)
Entity Type:Individual
Prefix:
First Name:SHIRAZ
Middle Name:
Last Name:LEVKOVICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4414
Mailing Address - Country:US
Mailing Address - Phone:617-758-9866
Mailing Address - Fax:
Practice Address - Street 1:1170 BEACON ST STE 301
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3963
Practice Address - Country:US
Practice Address - Phone:617-249-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty