Provider Demographics
NPI:1013161462
Name:LEVINE, MAYDAY R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAYDAY
Middle Name:R
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MAYDAY
Other - Middle Name:R
Other - Last Name:LEVINE-MATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:504 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3353
Mailing Address - Country:US
Mailing Address - Phone:520-437-9035
Mailing Address - Fax:520-622-7324
Practice Address - Street 1:504 W 29TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-3353
Practice Address - Country:US
Practice Address - Phone:520-437-9035
Practice Address - Fax:520-622-7324
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3896103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical