=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912319328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARBOR GROVE PSYCHOLOGICAL SERVICES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2014
-----------------------------------------------------
Last Update Date | 07/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 S BELLEVUE AVE 2ND FL. REAR
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-2862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-995-0140
-----------------------------------------------------
Fax | 215-947-0424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 S BELLEVUE AVE 2ND FL. REAR
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-2862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-995-0140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. GABRIEL SCOTT LEVIN
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 215-995-0140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS016830
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------