Healthcare Provider Details

I. General information

NPI: 1053859470
Provider Name (Legal Business Name): LAURA LEVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 S ROBERTSON BLVD
LOS ANGELES CA
90035-3414
US

IV. Provider business mailing address

1433 S ROBERTSON BLVD
LOS ANGELES CA
90035-3414
US

V. Phone/Fax

Practice location:
  • Phone: 310-785-2121
  • Fax:
Mailing address:
  • Phone: 310-785-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW75002
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: