MEDICARE: DR. ELAINE S. LEVINE 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	103TC2200X	Clinical Child & Adolescent Psychologist	189	NM
2	103TP0016X	Prescribing (Medical) Psychologist	0001	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851426159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE S. LEVINE PH.D.

Provider Business Mailing Address
First Line	:	1395 MISSOURI AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5327
Country	:	US
Telephone Number	:	575-522-5466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 MISSOURI AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5327
Country	:	US
Telephone Number	:	505-522-5466
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	12/09/2022

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