Healthcare Provider Details

I. General information

NPI: 1003567975
Provider Name (Legal Business Name): LEVY THERAPEUTICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 E 63RD ST
BROOKLYN NY
11234-6304
US

IV. Provider business mailing address

2224 E 63RD ST
BROOKLYN NY
11234-6304
US

V. Phone/Fax

Practice location:
  • Phone: 347-237-6543
  • Fax:
Mailing address:
  • Phone: 347-237-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIELLA LEVY
Title or Position: PRESIDENT
Credential: LMSW
Phone: 347-237-6543