Provider Demographics
NPI:1861559197
Name:LEVY, JOAN IRENE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:IRENE
Last Name:LEVY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3558 ROUND BARN BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1780
Mailing Address - Country:US
Mailing Address - Phone:707-571-3706
Mailing Address - Fax:707-571-3796
Practice Address - Street 1:3558 ROUND BARN BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1780
Practice Address - Country:US
Practice Address - Phone:707-571-3706
Practice Address - Fax:707-571-3796
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16396103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist