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Individual
DR. ETHAN R LEVINE
Active
Individual
DR. ETHAN R LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
NULL
103TA0700X
Adult Development & Aging Psychologist
Primary
—
NULL
103TC0700X
Clinical Psychologist
650
NC
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TE1100X
Exercise & Sports Psychologist
—
NULL
103TH0100X
Health Service Psychologist
—
NULL
103TR0400X
Rehabilitation Psychologist
—
NULL
Other
Enumeration date
03/13/2009
Last updated
04/08/2020
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