Provider Demographics
NPI:1851327944
Name:BIVENS;LEVIN, CAROL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:S
Last Name:BIVENS;LEVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:BIVENS-LEVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1660 HOTEL CIR N
Mailing Address - Street 2:STE 612
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2807
Mailing Address - Country:US
Mailing Address - Phone:619-497-1881
Mailing Address - Fax:619-497-1886
Practice Address - Street 1:1660 HOTEL CIR N
Practice Address - Street 2:STE 612
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2807
Practice Address - Country:US
Practice Address - Phone:619-497-1881
Practice Address - Fax:619-497-1886
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15528Medicare ID - Type Unspecified