Healthcare Provider Details

I. General information

NPI: 1598210767
Provider Name (Legal Business Name): LEVITAN AND ASSOCIATES PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E CAMELBACK RD STE 600
PHOENIX AZ
85016-3493
US

IV. Provider business mailing address

2375 E CAMELBACK RD STE 600
PHOENIX AZ
85016-3493
US

V. Phone/Fax

Practice location:
  • Phone: 602-529-1449
  • Fax:
Mailing address:
  • Phone: 602-387-5313
  • Fax: 602-387-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4709
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4709
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number4709
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEKSANDR LEVITAN
Title or Position: CEO
Credential: PSY.D.
Phone: 602-529-1449