Provider Demographics
NPI:1891835732
Name:MARKS, ABIGAIL LEVINSON (PHD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LEVINSON
Last Name:MARKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GOUGH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5945
Mailing Address - Country:US
Mailing Address - Phone:415-861-5449
Mailing Address - Fax:415-861-3252
Practice Address - Street 1:110 GOUGH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5945
Practice Address - Country:US
Practice Address - Phone:415-861-5449
Practice Address - Fax:415-861-3252
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL201290Medicare UPIN