Provider Demographics
NPI:1700117959
Name:LEVY, AMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:LEVY
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 1:910 TARIK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4653
Mailing Address - Country:US
Mailing Address - Phone:310-363-3688
Mailing Address - Fax:
Practice Address - Street 1:5007 SOUTHPARK DR STE 250
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7742
Practice Address - Country:US
Practice Address - Phone:310-363-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21333103T00000X
NC5328103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist