Provider Demographics
NPI:1922497783
Name:LEVENBERG, SCOTT ANDREW (MA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ANDREW
Last Name:LEVENBERG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:SIMCHA
Other - Middle Name:
Other - Last Name:LEVENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:419 N FORMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2524
Mailing Address - Country:US
Mailing Address - Phone:310-247-0534
Mailing Address - Fax:
Practice Address - Street 1:8838 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3302
Practice Address - Country:US
Practice Address - Phone:310-247-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 81637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist