Provider Demographics
NPI:1134163330
Name:LEVINSON, JUDITH (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BON AIR CTR
Mailing Address - Street 2:#225
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-3017
Mailing Address - Country:US
Mailing Address - Phone:415-927-3210
Mailing Address - Fax:415-924-4803
Practice Address - Street 1:100 TAMAL PLZ
Practice Address - Street 2:SUITE 102
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1125
Practice Address - Country:US
Practice Address - Phone:415-927-3210
Practice Address - Fax:415-924-4803
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12082103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200820OtherPIN # FOR MHN
CAOPL120821Medicare PIN
CA200820OtherPIN # FOR MHN