Provider Demographics
NPI:1740363225
Name:LEVINE, BRIAN EVAN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EVAN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 27TH ST APT 7K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9224
Mailing Address - Country:US
Mailing Address - Phone:212-685-4991
Mailing Address - Fax:
Practice Address - Street 1:199 JAY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1907
Practice Address - Country:US
Practice Address - Phone:718-488-0100
Practice Address - Fax:718-488-0128
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004759103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV30022Medicare ID - Type Unspecified