Provider Demographics
NPI:1457806796
Name:LEVITAN, ALEKSANDR (PSYD)
Entity type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:LEVITAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:LEVITAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2375 E CAMELBACK RD STE 600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3493
Mailing Address - Country:US
Mailing Address - Phone:602-387-5313
Mailing Address - Fax:602-387-5001
Practice Address - Street 1:2375 E CAMELBACK RD STE 600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3493
Practice Address - Country:US
Practice Address - Phone:602-387-5313
Practice Address - Fax:602-387-5001
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4709103TB0200X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
13853693OtherCAQH