Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY7980 | FL |
N | 103G00000X | Clinical Psychologist | PY7980 | FL |
N | 103TC0700X | Clinical Psychologist | PY7980 | FL |
Y | 103TH0004X | Health Psychologist | PY7980 | FL |
NPI | 1154776557 |
---|---|
Provider Name | Dr. Gary K Levenston |
First Address | Deerfield Beach, FL 33442-7619 |
Second Address | Boca Raton, FL 33431-7209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 04/05/2016 |