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General NPI Number Information
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NPI Number | 1194930818
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Entity Type | Organization
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Legal Business Name | M.D. LEVY, PHD. A PSYCHOLOGICAL GROUP INC.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6333 WILSHIRE BLVD STE 506
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City | LOS ANGELES
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State | CA
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Zip | 90048-5702
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Country | US
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Telephone | 323-938-9233
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Fax | 323-938-0226
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Provider Business Mailing Address
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Address Line | 6128 MARYLAND DR
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City | LOS ANGELES
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State | CA
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Zip | 90048-4736
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Country | US
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Telephone | 323-938-9233
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Fax | 323-938-0266
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHIRLEY D. LEVY
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Credential | PHD.
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Telephone | 323-938-9233
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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 | PSY9285
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License Number State | CA
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