1508916479 NPI number — MRS. KAREN S LEVY L.P.C.C.

Table of content: MRS. KAREN S LEVY L.P.C.C. (NPI 1508916479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508916479 NPI number — MRS. KAREN S LEVY L.P.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVY
Provider First Name:
KAREN
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.C.
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:
1508916479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 FARRELL DRIVE
Provider Second Line Business Mailing Address:
P.O. BOX 2680
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41012-2680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-578-3228
Provider Business Mailing Address Fax Number:
859-578-3270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 BARNES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41097-9483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-824-4442
Provider Business Practice Location Address Fax Number:
859-824-4448
Provider Enumeration Date:
01/11/2007

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: 101YM0800X , with the licence number:  283 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30615058 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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