Provider Demographics
NPI:1265895155
Name:LEVIN, RUTH
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N LANSDOWNE AVE APT 4J2
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2053
Mailing Address - Country:US
Mailing Address - Phone:610-453-5113
Mailing Address - Fax:
Practice Address - Street 1:111 N. LANSDOWNE AVE. BLDG 4 J2
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050
Practice Address - Country:US
Practice Address - Phone:610-453-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000431103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst