Provider Demographics
NPI:1124759725
Name:LEVY, SUE RICHMOND
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:RICHMOND
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 KENT ST APT 10
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7917
Mailing Address - Country:US
Mailing Address - Phone:617-699-6393
Mailing Address - Fax:
Practice Address - Street 1:74 KENT ST APT 10
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7917
Practice Address - Country:US
Practice Address - Phone:617-699-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach