Provider Demographics
NPI:1881015725
Name:LEVY, ANGEL A
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:A
Last Name:LEVY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 DAVIDSON AVE
Mailing Address - Street 2:APT: 5A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-8325
Mailing Address - Country:US
Mailing Address - Phone:718-294-5511
Mailing Address - Fax:
Practice Address - Street 1:335 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3655
Practice Address - Country:US
Practice Address - Phone:315-343-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272225022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health