Provider Demographics
NPI:1487489118
Name:MICHAL 'MICA' LEVI, PH.D. PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:MICHAL 'MICA' LEVI, PH.D. PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-358-6551
Mailing Address - Street 1:1130 WALL ST STE 595
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4531
Mailing Address - Country:US
Mailing Address - Phone:858-358-6551
Mailing Address - Fax:858-216-1899
Practice Address - Street 1:5252 BALBOA AVE STE 803
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6920
Practice Address - Country:US
Practice Address - Phone:858-358-6551
Practice Address - Fax:858-216-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty