Provider Demographics
NPI:1194930818
Name:M.D. LEVY, PHD. A PSYCHOLOGICAL GROUP INC.
Entity type:Organization
Organization Name:M.D. LEVY, PHD. A PSYCHOLOGICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-938-9233
Mailing Address - Street 1:6128 MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4736
Mailing Address - Country:US
Mailing Address - Phone:323-938-9233
Mailing Address - Fax:323-938-0266
Practice Address - Street 1:6333 WILSHIRE BLVD
Practice Address - Street 2:STE 506
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5702
Practice Address - Country:US
Practice Address - Phone:323-938-9233
Practice Address - Fax:323-938-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGPS489348Medicaid
CAGPS489348Medicaid