Provider Demographics
NPI:1376365528
Name:LEVENBERG, WILLIAM J
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:LEVENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 VICTORIA PARK DR # 90019
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4209
Mailing Address - Country:US
Mailing Address - Phone:310-295-8032
Mailing Address - Fax:
Practice Address - Street 1:4453 VICTORIA PARK DR # 90019
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4209
Practice Address - Country:US
Practice Address - Phone:310-295-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty