Healthcare Provider Details

I. General information

NPI: 1215313523
Provider Name (Legal Business Name): MARK LEVINE M.D. MINDFULNESS ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 DOUGLAS BLVD STE 300
ROSEVILLE CA
95661-3850
US

IV. Provider business mailing address

26645 NORMANDY RD
FRANKLIN MI
48025-1033
US

V. Phone/Fax

Practice location:
  • Phone: 855-500-6463
  • Fax: 844-553-6337
Mailing address:
  • Phone: 916-241-9496
  • Fax: 916-436-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARK DAVID LEVINE
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 530-902-4976