MEDICARE: DR. ANDREW JEREMIAH LEVINE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY20320	CA
2	103G00000X	Clinical Neuropsychologist	PSY20320	CA

General Provider Information

NPI Number	:	1003807876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW JEREMIAH LEVINE PH.D.

Provider Business Mailing Address
First Line	:	592 14TH ST
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-5808
Country	:	US
Telephone Number	:	707-595-7997
Fax Number	:	510-280-2993

Provider Business Practice Location Address
First Line	:	592 14TH ST
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-5808
Country	:	US
Telephone Number	:	707-595-7997
Fax Number	:	510-280-2993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/30/2025

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Directions to “ DR. ANDREW JEREMIAH LEVINE PH.D.” Practice Location

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