Provider Demographics
NPI:1962935023
Name:LEVY, CAROLINE
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 S BOULDIN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5022
Mailing Address - Country:US
Mailing Address - Phone:484-431-6494
Mailing Address - Fax:410-517-2113
Practice Address - Street 1:11500 CRONRIDGE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2261
Practice Address - Country:US
Practice Address - Phone:484-431-6494
Practice Address - Fax:410-517-2113
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBCBA 1-16-24931103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst