Healthcare Provider Details

I. General information

NPI: 1205004132
Provider Name (Legal Business Name): JASON L. LEVINE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 HORN AVE APT 610
WEST HOLLYWOOD CA
90069-2119
US

IV. Provider business mailing address

1230 HORN AVE APT 610
WEST HOLLYWOOD CA
90069-2119
US

V. Phone/Fax

Practice location:
  • Phone: 310-488-1116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: