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General NPI Number Information
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NPI Number | 1013115971
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Entity Type | Individual
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Provider Name | MARC LAWRENCE LEVITT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11500 W OLYMPIC BLVD 500
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City | LOS ANGELES
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State | CA
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Zip | 90064-1524
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Country | US
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Telephone | 310-477-9492
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Fax | 310-478-6698
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Provider Business Mailing Address
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Address Line | 56 SAUSALITO CIR E
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-7253
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Country | US
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Telephone | 310-545-1216
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 6722
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License Number State | CA
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