Provider Demographics
NPI:1306945282
Name:LEVITT, JANICE BLOOM (MS)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:BLOOM
Last Name:LEVITT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 YORK RD STE 301
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6054
Mailing Address - Country:US
Mailing Address - Phone:443-858-0541
Mailing Address - Fax:410-321-7906
Practice Address - Street 1:1407 YORK RD STE 301
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6054
Practice Address - Country:US
Practice Address - Phone:443-858-0541
Practice Address - Fax:410-321-7906
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional