Provider Demographics
NPI:1174715569
Name:LEVIS, JENNIFER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:LEVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 E DEL MAR BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4321
Mailing Address - Country:US
Mailing Address - Phone:626-356-0363
Mailing Address - Fax:626-356-0466
Practice Address - Street 1:2810 E DEL MAR BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4321
Practice Address - Country:US
Practice Address - Phone:626-356-0363
Practice Address - Fax:626-356-0466
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical