MEDICARE: DR. AUDREY JANIS LEVY PSY.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	106H00000X	Marriage & Family Therapist	MFC 13387	CA

General Provider Information

NPI Number	:	1184922213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY JANIS LEVY PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 10358
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90295-6358
Country	:	US
Telephone Number	:	310-306-7750
Fax Number	:	310-822-3186

Provider Business Practice Location Address
First Line	:	13101 W WASHINGTON BLVD
Second Line	:	# 422
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5131
Country	:	US
Telephone Number	:	310-306-7750
Fax Number	:	310-822-3186

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

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

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