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NPI Code Detail

MEDICARE: DR. ELLEN LEVITZ PHD

MEDICARE: DR. ELLEN LEVITZ PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist01626MO

General Provider Information

NPI Number : 1902976541
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLEN LEVITZ PHD
Provider Business Mailing Address
First Line : 621 HARPER AVE
Second Line :
City : WEBSTER GROVES
State : MO
Zip : 63119-2216
Country : US
Telephone Number : 314-962-7788
Fax Number : 314-962-4158
Provider Business Practice Location Address
First Line : 8772 BIG BEND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63119-3730
Country : US
Telephone Number : 314-962-7788
Fax Number : 314-962-4158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 10/02/2007

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