Provider Demographics
NPI:1295711455
Name:LEVY-LARSON, RHONDA BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:BETH
Last Name:LEVY-LARSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 ORCHARD LAKE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3605
Mailing Address - Country:US
Mailing Address - Phone:248-661-3900
Mailing Address - Fax:248-661-9209
Practice Address - Street 1:7001 ORCHARD LAKE RD STE 130
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3605
Practice Address - Country:US
Practice Address - Phone:248-661-3900
Practice Address - Fax:248-661-9209
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006751103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR66873Medicare UPIN