1184922213 NPI number — DR. AUDREY JANIS LEVY PSY.D.

Table of content: DR. AUDREY JANIS LEVY PSY.D. (NPI 1184922213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184922213 NPI number — DR. AUDREY JANIS LEVY PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVY
Provider First Name:
AUDREY
Provider Middle Name:
JANIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184922213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10358
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARINA DEL REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90295-6358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-306-7750
Provider Business Mailing Address Fax Number:
310-822-3186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13101 W WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
# 422
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90066-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-306-7750
Provider Business Practice Location Address Fax Number:
310-822-3186
Provider Enumeration Date:
03/15/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 13387 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)