Provider Demographics
NPI:1902385800
Name:LEVENSON, LAUREN NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:NICOLE
Last Name:LEVENSON
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 1:401 E 88TH ST APT 8G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6636
Mailing Address - Country:US
Mailing Address - Phone:917-842-2220
Mailing Address - Fax:
Practice Address - Street 1:148 W 90TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1202
Practice Address - Country:US
Practice Address - Phone:917-842-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022759103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist