Provider Demographics
NPI:1831629724
Name:LEVY, BENJAMIN B
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:B
Last Name:LEVY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHENBO
Other - Middle Name:B
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6180 93RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5046
Mailing Address - Country:US
Mailing Address - Phone:425-281-7078
Mailing Address - Fax:
Practice Address - Street 1:2120 S PLUM ST STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4539
Practice Address - Country:US
Practice Address - Phone:206-203-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health