Healthcare Provider Details

I. General information

NPI: 1114087533
Provider Name (Legal Business Name): BARRETT G LEVINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE BLDG W
FRESNO CA
93705-4206
US

IV. Provider business mailing address

10 PICO CT
ORINDA CA
94563-4130
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax:
Mailing address:
  • Phone: 510-862-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG35389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG35389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: