MEDICARE: ANTHONIA LEVY PH.D., LMHC, LPC.

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	101Y00000X	Counselor	0701006395	VA
2	101Y00000X	Counselor	LC4739	MD
3	101YM0800X	Mental Health Counselor	MH15316	FL

General Provider Information

NPI Number	:	1083967145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONIA LEVY PH.D., LMHC, LPC.

Provider Business Mailing Address
First Line	:	157 HAMPTON POINT DR STE 1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3054
Country	:	US
Telephone Number	:	904-415-3755
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 HAMPTON POINT DR STE 1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3054
Country	:	US
Telephone Number	:	904-415-3755
Fax Number	:

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

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	10/31/2017

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