Provider Demographics
NPI:1003807876
Name:LEVINE, ANDREW JEREMIAH (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JEREMIAH
Last Name:LEVINE
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 1:592 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5808
Mailing Address - Country:US
Mailing Address - Phone:707-595-7997
Mailing Address - Fax:510-280-2993
Practice Address - Street 1:592 14TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5808
Practice Address - Country:US
Practice Address - Phone:707-595-7997
Practice Address - Fax:510-280-2993
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20320103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist