MEDICARE: DR. MAURICE ADAM LEVY 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	016660-1	NY
2	103TB0200X	Cognitive & Behavioral Psychologist	29728	CA
3	103TC0700X	Clinical Psychologist	29728	CA
4	103TC0700X	Clinical Psychologist	016660-1	NY
5	103TC2200X	Clinical Child & Adolescent Psychologist	29728	CA
6	103TC2200X	Clinical Child & Adolescent Psychologist	016660-1	NY
7	103TM1800X	Intellectual & Developmental Disabilities Psychologist	29728	CA
8	103TS0200X	School Psychologist	29728	CA
9	103TS0200X	School Psychologist	0166601	NY
10	103TB0200X	Cognitive & Behavioral Psychologist	016660-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-5987838	OTHER	NY	EMPLOYEE ID #

General Provider Information

NPI Number	:	1972637668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICE ADAM LEVY PH.D.

Provider Business Mailing Address
First Line	:	101 N INDIAN HILL BLVD
Second Line	:	STE- C1-200
City	:	CLAREMONT
State	:	CA
Zip	:	91711
Country	:	US
Telephone Number	:	866-200-9090
Fax Number	:	516-468-6028

Provider Business Practice Location Address
First Line	:	101 N INDIAN HILL BLVD STE C1-200
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4667
Country	:	US
Telephone Number	:	866-200-9090
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/04/2018

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