Provider Demographics
NPI:1134377294
Name:LEVIN, JUDITH B (PSYD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:B
Last Name:LEVIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013 WALLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3731
Mailing Address - Country:US
Mailing Address - Phone:610-952-6419
Mailing Address - Fax:410-484-5400
Practice Address - Street 1:104 CHURCH LN
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3786
Practice Address - Country:US
Practice Address - Phone:410-484-3037
Practice Address - Fax:410-484-5400
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04239103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014900610002Medicaid
096339Medicare PIN