Provider Demographics
NPI:1013096031
Name:LEVIN, JODIE (MFT)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:LEVIN
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 1:12214 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3830
Mailing Address - Country:US
Mailing Address - Phone:818-209-2090
Mailing Address - Fax:818-980-5222
Practice Address - Street 1:12214 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3830
Practice Address - Country:US
Practice Address - Phone:818-209-2090
Practice Address - Fax:818-980-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35931106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist