Provider Demographics
NPI:1386771087
Name:BAR-LEVAV, LEORA PNINA (MD)
Entity type:Individual
Prefix:DR
First Name:LEORA
Middle Name:PNINA
Last Name:BAR-LEVAV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29600 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1016
Mailing Address - Country:US
Mailing Address - Phone:248-353-0050
Mailing Address - Fax:248-353-8107
Practice Address - Street 1:29600 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1016
Practice Address - Country:US
Practice Address - Phone:248-353-0050
Practice Address - Fax:248-353-8107
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health