Provider Demographics
NPI:1184922213
Name:LEVY, AUDREY JANIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:JANIS
Last Name:LEVY
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:PO BOX 10358
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90295-6358
Mailing Address - Country:US
Mailing Address - Phone:310-306-7750
Mailing Address - Fax:310-822-3186
Practice Address - Street 1:13101 W WASHINGTON BLVD
Practice Address - Street 2:# 422
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5131
Practice Address - Country:US
Practice Address - Phone:310-306-7750
Practice Address - Fax:310-822-3186
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 13387106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist