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General NPI Number Information
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NPI Number | 1003807876
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Entity Type | Individual
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Provider Name | ANDREW JEREMIAH LEVINE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 592 14TH ST
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City | ARCATA
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State | CA
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Zip | 95521-5808
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Country | US
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Telephone | 707-595-7997
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Fax | 510-280-2993
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Provider Business Mailing Address
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Address Line | 592 14TH ST
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City | ARCATA
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State | CA
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Zip | 95521-5808
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Country | US
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Telephone | 707-595-7997
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Fax | 510-280-2993
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY20320
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY20320
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License Number State | CA
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