Provider Demographics
NPI:1134840606
Name:LEVY, JUDITH N (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:N
Last Name:LEVY
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 1:5701 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1717
Mailing Address - Country:US
Mailing Address - Phone:510-386-5000
Mailing Address - Fax:
Practice Address - Street 1:5701 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1717
Practice Address - Country:US
Practice Address - Phone:510-386-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist