Provider Demographics
NPI:1205968583
Name:LEVY, MIRIAM A (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:A
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 1:4 BACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4404
Mailing Address - Country:US
Mailing Address - Phone:603-740-9789
Mailing Address - Fax:603-742-1373
Practice Address - Street 1:4 BACK RIVER RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4404
Practice Address - Country:US
Practice Address - Phone:603-740-9789
Practice Address - Fax:603-742-1373
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical