Provider Demographics
NPI:1972848000
Name:LEVINE, TIFFANY A (MFT)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:A
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17846 LECCO LN
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3100
Mailing Address - Country:US
Mailing Address - Phone:310-729-0510
Mailing Address - Fax:
Practice Address - Street 1:17846 LECCO LN
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3100
Practice Address - Country:US
Practice Address - Phone:310-729-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist