Provider Demographics
NPI:1649095456
Name:LEVINE, LEORA (PSYD)
Entity type:Individual
Prefix:
First Name:LEORA
Middle Name:
Last Name:LEVINE
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 1:350 CENTRAL PARK W APT 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8842
Mailing Address - Country:US
Mailing Address - Phone:646-580-1749
Mailing Address - Fax:
Practice Address - Street 1:350 CENTRAL PARK W APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8842
Practice Address - Country:US
Practice Address - Phone:646-580-1749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ243-075390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program