Healthcare Provider Details

I. General information

NPI: 1538645411
Provider Name (Legal Business Name): MEREDITH LEVY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date: 12/25/2019
Reactivation Date: 02/23/2022

III. Provider practice location address

585 STEWART AVE
GARDEN CITY NY
11530-4783
US

IV. Provider business mailing address

25 FIRETHORNE LN
VALLEY STREAM NY
11581-1753
US

V. Phone/Fax

Practice location:
  • Phone: 516-280-7285
  • Fax:
Mailing address:
  • Phone: 516-639-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: