Provider Demographics
NPI:1134161300
Name:LEVINE, KATHY (MS, RD, CDN)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 TODD RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2807
Mailing Address - Country:US
Mailing Address - Phone:914-767-0734
Mailing Address - Fax:
Practice Address - Street 1:190 GOLDENS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2804
Practice Address - Country:US
Practice Address - Phone:914-767-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072746OtherAETNA
P2526854OtherOXFORD
2165213003OtherCIGNA
2072746OtherAETNA