Provider Demographics
NPI:1962522086
Name:LEVINGSTON, DAVID F (MA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:F
Last Name:LEVINGSTON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 WESTERN AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6953
Mailing Address - Country:US
Mailing Address - Phone:415-717-0918
Mailing Address - Fax:802-727-4634
Practice Address - Street 1:229 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6589
Practice Address - Country:US
Practice Address - Phone:415-717-0918
Practice Address - Fax:802-727-4634
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44173106H00000X
VT100-0000054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014719Medicaid