Healthcare Provider Details

I. General information

NPI: 1003807876
Provider Name (Legal Business Name): ANDREW JEREMIAH LEVINE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 14TH ST
ARCATA CA
95521-5808
US

IV. Provider business mailing address

592 14TH ST
ARCATA CA
95521-5808
US

V. Phone/Fax

Practice location:
  • Phone: 707-595-7997
  • Fax: 510-280-2993
Mailing address:
  • Phone: 707-595-7997
  • Fax: 510-280-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY20320
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY20320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: