Basic Information
| Provider Information | |||||||||
| NPI: | 1538172770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVENSON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | MORGAN | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 448 22ND ST | ||||||||
| Address2: | |||||||||
| City: | BELLEAIR BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337863415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273986661 | ||||||||
| FaxNumber: | 7273989515 | ||||||||
| Practice Location | |||||||||
| Address1: | 10,000 BAY PINES BOULEVARD | ||||||||
| Address2: | BAY PINES HEALTH CARE SYSTEM | ||||||||
| City: | BAY PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273986661 | ||||||||
| FaxNumber: | 7273989515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY 3380 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.