Provider Demographics
NPI:1487982252
Name:LEVIN, SUSAN N (MA, MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:N
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16055 VENTURA BLVD STE 1010
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2611
Mailing Address - Country:US
Mailing Address - Phone:818-404-0459
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 1010
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2611
Practice Address - Country:US
Practice Address - Phone:818-404-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health