Provider Demographics
NPI:1306350749
Name:LEVY, SOPHIE RACHEL (LMFT)
Entity type:Individual
Prefix:MS
First Name:SOPHIE
Middle Name:RACHEL
Last Name:LEVY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SOPHIE
Other - Middle Name:R
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1137 2ND ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5085
Mailing Address - Country:US
Mailing Address - Phone:424-216-1679
Mailing Address - Fax:
Practice Address - Street 1:1137 2ND ST STE 203
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5085
Practice Address - Country:US
Practice Address - Phone:424-216-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health