=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790836286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARSHA H. LEVY-WARREN, PH.D, PSYCHOLOGIST, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 666 W END AVE SUITE 1A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-7357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-873-2997
-----------------------------------------------------
Fax | 212-666-3135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 666 W END AVE SUITE 1A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-7357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-873-2997
-----------------------------------------------------
Fax | 212-666-3135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARSHA H. LEVY-WARREN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 212-873-2997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6680
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------