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General NPI Number Information
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NPI Number | 1124201983
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Entity Type | Organization
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Legal Business Name | SUE LEVY PSYD LCSW PA
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 3959 S NOVA ROAD BLDG B SUITE 23
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City | PORT ORANGE
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State | FL
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Zip | 32127-9229
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Country | US
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Telephone | 386-253-8439
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Fax | 386-253-8439
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Provider Business Mailing Address
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Address Line | 3959 S NOVA ROAD BLDG B SUITE 23
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City | PORT ORANGE
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State | FL
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Zip | 32127-9229
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Country | US
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Telephone | 386-253-8439
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Fax | 386-253-8579
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Authorized Official
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Title or Position | PRESIDENT/PSYCHOLOGIST
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Name | SUE LEVY
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Credential | PSYD LCSW
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Telephone | 386-253-8439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW0002513
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License Number State | FL
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