Provider Demographics
NPI:1558096776
Name:LEVY, RICHARD A
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:LEVY
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 1:30 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4104
Mailing Address - Country:US
Mailing Address - Phone:609-444-9265
Mailing Address - Fax:
Practice Address - Street 1:233 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4204
Practice Address - Country:US
Practice Address - Phone:860-826-1358
Practice Address - Fax:860-731-5536
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1558096776Medicaid