Provider Demographics
NPI:1033942891
Name:LEVY, CHARLES ERIC (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ERIC
Last Name:LEVY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:20977 MOUSETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-2229
Mailing Address - Country:US
Mailing Address - Phone:301-346-7307
Mailing Address - Fax:
Practice Address - Street 1:19634 CLUB HOUSE RD
Practice Address - Street 2:#315
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886
Practice Address - Country:US
Practice Address - Phone:301-580-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical