Provider Demographics
NPI:1770960403
Name:LEVIT, ROBERT (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LEVIT
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 1:20 S SANTA CRUZ AVE STE 315
Mailing Address - Street 2:1
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6834
Mailing Address - Country:US
Mailing Address - Phone:408-993-3840
Mailing Address - Fax:408-356-8997
Practice Address - Street 1:20 S SANTA CRUZ AVE STE 315
Practice Address - Street 2:1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6834
Practice Address - Country:US
Practice Address - Phone:408-993-3840
Practice Address - Fax:408-356-8997
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11220103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent