Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1003315250 |
---|---|
Provider Name | Bruce Marshall Levine |
First Address | Plainville, CT 06062-1534 |
Second Address | Plainville, CT 06062-1534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2018 |
Last Update Date | 02/02/2018 |