Provider Demographics
NPI:1093880726
Name:LEVNER, CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:LEVNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 HENRY HUDSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1502
Mailing Address - Country:US
Mailing Address - Phone:718-549-0243
Mailing Address - Fax:718-548-6766
Practice Address - Street 1:3736 HENRY HUDSON PKWY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1502
Practice Address - Country:US
Practice Address - Phone:718-549-0243
Practice Address - Fax:718-548-6766
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8970103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist