Provider Demographics
NPI:1952632077
Name:LEOVIN, TANIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:LEOVIN
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 1:2872 MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4349
Mailing Address - Country:US
Mailing Address - Phone:310-838-4083
Mailing Address - Fax:
Practice Address - Street 1:2872 MANNING AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4349
Practice Address - Country:US
Practice Address - Phone:310-838-4083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11218103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist