Provider Demographics
NPI:1427153279
Name:LEVY, MARSHALL (PHD)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13263 VENTURA BLVD
Mailing Address - Street 2:#2
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1839
Mailing Address - Country:US
Mailing Address - Phone:818-501-6090
Mailing Address - Fax:818-501-6095
Practice Address - Street 1:2335 SOUTH MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:DURATE
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-357-3207
Practice Address - Fax:626-301-9590
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY54240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY54240Medicaid
S08822Medicare UPIN
WCP5424BMedicare ID - Type Unspecified