Healthcare Provider Details

I. General information

NPI: 1558096776
Provider Name (Legal Business Name): RICHARD A LEVY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN ST
NEW BRITAIN CT
06051-4204
US

IV. Provider business mailing address

30 BREWSTER RD
ENFIELD CT
06082-4104
US

V. Phone/Fax

Practice location:
  • Phone: 860-826-1358
  • Fax: 860-731-5536
Mailing address:
  • Phone: 609-444-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7295
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: