Provider Demographics
NPI:1801931894
Name:BARROR-LEVINE, JENNIFER HAYLEY (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAYLEY
Last Name:BARROR-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 1:4107 W SPRUCE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2327
Mailing Address - Country:US
Mailing Address - Phone:813-636-8811
Mailing Address - Fax:813-636-8855
Practice Address - Street 1:4107 W SPRUCE ST
Practice Address - Street 2:STE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2327
Practice Address - Country:US
Practice Address - Phone:813-636-8811
Practice Address - Fax:813-636-8855
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007373100Medicaid
FL007373100Medicaid
FL007373100Medicaid