MEDICARE: MR. RICHARD LEVINE M.F.T.

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	106H00000X	Marriage & Family Therapist	MFC 20200	CA

General Provider Information

NPI Number	:	1134361579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD LEVINE M.F.T.

Provider Business Mailing Address
First Line	:	1617 N. EL CENTRO AVENUE
Second Line	:	SUITE #16
City	:	LOS ANGELES
State	:	CA
Zip	:	90028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 N. EL CENTRO AVENUE
Second Line	:	SUITE #16
City	:	LOS ANGELES
State	:	CA
Zip	:	90028
Country	:	US
Telephone Number	:	323-344-0440
Fax Number	:

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

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	09/19/2011

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