=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114909546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANN LEVY PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2005
-----------------------------------------------------
Last Update Date | 08/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5535 BALBOA BLVD STE 209
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-1585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-775-2959
-----------------------------------------------------
Fax | 818-727-1333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5535 BALBOA BLVD STE 209
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-1585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-775-2959
-----------------------------------------------------
Fax | 818-727-1333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY9550
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------