Provider Demographics
NPI:1720177587
Name:LEVIN, CHERYL PAULA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:PAULA
Last Name:LEVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 REGAL MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CTR
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6580
Mailing Address - Country:US
Mailing Address - Phone:617-396-4695
Mailing Address - Fax:148-478-4011
Practice Address - Street 1:916 REGAL MANOR WAY
Practice Address - Street 2:
Practice Address - City:SUN CITY CTR
Practice Address - State:FL
Practice Address - Zip Code:33573-6580
Practice Address - Country:US
Practice Address - Phone:617-396-4695
Practice Address - Fax:148-478-4011
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2117103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA30514OtherNATIONAL REGISTER