Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ASW75002 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1053859470 |
---|---|
Provider Name | Laura Levin |
First Address | Los Angeles, CA 90035-3414 |
Second Address | Los Angeles, CA 90035-3414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 12/02/2018 |