Basic Information
| Provider Information | |||||||||
| NPI: | 1609302306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10300 SW 72ND ST STE 114 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331733038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548056561 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10300 SW 72ND ST STE 114 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331733038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055085580 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2017 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | 0-19-10333 | FL | N | 106S00000X | RBT-17-37465 | FL | N | 103K00000X | 1-21-49138 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.