Healthcare Provider Details

I. General information

NPI: 1154641900
Provider Name (Legal Business Name): LEVINE-ADLER P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E TRAVELERS TRL SUITE 225
BURNSVILLE MN
55337-4097
US

IV. Provider business mailing address

200 E TRAVELERS TRL SUITE 225
BURNSVILLE MN
55337-4097
US

V. Phone/Fax

Practice location:
  • Phone: 952-707-1820
  • Fax:
Mailing address:
  • Phone: 952-707-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2202
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP2202
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP2202
License Number StateMN

VIII. Authorized Official

Name: DR. LESLIE LEVINE ADLER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 952-707-1820