MEDICARE: DR. RHONDA BETH LEVY-LARSON 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	103G00000X	Clinical Neuropsychologist	6301006751	MI
2	103T00000X	Psychologist	6301006751	MI
3	103TC0700X	Clinical Psychologist	6301006751	MI

General Provider Information

NPI Number	:	1295711455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RHONDA BETH LEVY-LARSON PH.D.

Provider Business Mailing Address
First Line	:	7001 ORCHARD LAKE RD STE 130
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3605
Country	:	US
Telephone Number	:	248-661-3900
Fax Number	:	248-661-9209

Provider Business Practice Location Address
First Line	:	7001 ORCHARD LAKE RD STE 130
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3605
Country	:	US
Telephone Number	:	248-661-3900
Fax Number	:	248-661-9209

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	10/31/2023

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