Provider Demographics
NPI:1972637668
Name:LEVY, MAURICE ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:ADAM
Last Name:LEVY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N INDIAN HILL BLVD
Mailing Address - Street 2:STE- C1-200
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:866-200-9090
Mailing Address - Fax:516-468-6028
Practice Address - Street 1:101 N INDIAN HILL BLVD STE C1-200
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4667
Practice Address - Country:US
Practice Address - Phone:866-200-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016660-1103T00000X, 103TC0700X, 103TC2200X, 103TB0200X
CA29728103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X, 103TS0200X
NY0166601103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-5987838OtherEMPLOYEE ID #
NY03157839Medicaid