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General NPI Number Information
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NPI Number | 1164588208
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Entity Type | Individual
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Provider Name | JENNIFER LEVINE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 16055 VENTURA BLVD SUITE 1033
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City | ENCINO
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State | CA
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Zip | 91436-2601
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Country | US
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Telephone | 310-499-7070
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Fax | 810-815-7070
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Provider Business Mailing Address
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Address Line | 5627 KANAN RD STE 157
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City | AGOURA HILLS
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State | CA
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Zip | 91301-3358
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Country | US
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Telephone | 310-499-7070
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Fax | 810-815-7070
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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 | PSY20579
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License Number State | CA
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