Healthcare Provider Details

I. General information

NPI: 1366549487
Provider Name (Legal Business Name): LEVINE, RISEN & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23230 CHAGRIN BLVD SUITE 350
BEACHWOOD OH
44122-5446
US

IV. Provider business mailing address

23230 CHAGRIN BLVD SUITE 350
BEACHWOOD OH
44122-5446
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-2900
  • Fax: 216-831-4306
Mailing address:
  • Phone: 216-831-2900
  • Fax: 216-831-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDACE B RISEN
Title or Position: VICE PRESIDENT
Credential: LISW
Phone: 216-831-2900