Healthcare Provider Details

I. General information

NPI: 1730148404
Provider Name (Legal Business Name): CAROL ANN LEVETT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 STATE ROUTE 81
WEST COXSACKIE NY
12192-1202
US

IV. Provider business mailing address

104 STATE ROUTE 81
WEST COXSACKIE NY
12192-1202
US

V. Phone/Fax

Practice location:
  • Phone: 518-755-7935
  • Fax: 518-751-1317
Mailing address:
  • Phone: 518-755-7935
  • Fax: 518-751-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number005385-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005385-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: