MEDICARE: SOPHIA LEVINSON 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	103T00000X	Psychologist	8650	CA
2	103TB0200X	Cognitive & Behavioral Psychologist	8650	CA
3	103TC0700X	Clinical Psychologist	8650	CA
4	103TC2200X	Clinical Child & Adolescent Psychologist	8650	CA

General Provider Information

NPI Number	:	1821425646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA LEVINSON PH.D.

Provider Business Mailing Address
First Line	:	2848 MEDILL PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-4644
Country	:	US
Telephone Number	:	310-559-9087
Fax Number	:	310-559-3907

Provider Business Practice Location Address
First Line	:	2848 MEDILL PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-4644
Country	:	US
Telephone Number	:	310-559-9087
Fax Number	:	310-559-3907

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

Provider Enumeration Date	:	10/11/2013
Last Update Date	:	10/11/2013

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