Provider Demographics
NPI:1154312171
Name:LEVINE, STUART HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:HOWARD
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:HOWARD
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MHA
Mailing Address - Street 1:540 S HELBERTA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4353
Mailing Address - Country:US
Mailing Address - Phone:310-543-1335
Mailing Address - Fax:310-543-6826
Practice Address - Street 1:540 S HELBERTA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4353
Practice Address - Country:US
Practice Address - Phone:310-354-4225
Practice Address - Fax:310-543-6826
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG579102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry