Healthcare Provider Details

I. General information

NPI: 1326458399
Provider Name (Legal Business Name): MR. JOSEPH LEVINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 COLUMBUS ROAD
BEDFORD HEIGHTS OH
44146
US

IV. Provider business mailing address

23600 COLUMBUS ROAD
BEDFORD HEIGHTS OH
44146
US

V. Phone/Fax

Practice location:
  • Phone: 440-439-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: