MEDICARE: KAREN LEVINE PHD

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	103TC0700X	Clinical Psychologist	016870	NY
2	103TC0700X	Clinical Psychologist	21013	CA

General Provider Information

NPI Number	:	1235220062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LEVINE PHD

Provider Business Mailing Address
First Line	:	428 GRAND AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-1635
Country	:	US
Telephone Number	:	213-924-5003
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 GRAND AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-1635
Country	:	US
Telephone Number	:	213-924-5003
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	06/24/2022

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Directions to “ KAREN LEVINE PHD” Practice Location

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