Provider Demographics
NPI:1841342250
Name:LEVIN, MICKI (PHD)
Entity type:Individual
Prefix:DR
First Name:MICKI
Middle Name:
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 1:43902 WOODWARD AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5011
Mailing Address - Country:US
Mailing Address - Phone:248-644-3371
Mailing Address - Fax:248-644-5033
Practice Address - Street 1:43902 WOODWARD AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5011
Practice Address - Country:US
Practice Address - Phone:248-644-3371
Practice Address - Fax:248-644-5033
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR67260Medicare UPIN
MIOF34901Medicare ID - Type Unspecified