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NPI Code Detail

MEDICARE: MRS. SANDRA MARKLEY LEVINE M.A., L.,L.P.

MEDICARE: MRS. SANDRA MARKLEY LEVINE M.A., L.,L.P.
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
1103T00000XPsychologist6301008263MI

General Provider Information

NPI Number : 1629147855
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA MARKLEY LEVINE M.A., L.,L.P.
Provider Business Mailing Address
First Line : 2304 BLUE SMOKE TRL
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-6704
Country : US
Telephone Number : 574-255-5995
Fax Number :
Provider Business Practice Location Address
First Line : 960 E STATE ST
Second Line :
City : CASSOPOLIS
State : MI
Zip : 49031-9339
Country : US
Telephone Number : 269-445-2451
Fax Number : 269-445-3836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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