Provider Demographics
NPI:1235605650
Name:LEVANDA, LIYA (PSYD)
Entity type:Individual
Prefix:
First Name:LIYA
Middle Name:
Last Name:LEVANDA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-0143
Mailing Address - Country:US
Mailing Address - Phone:510-831-0122
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 143
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-0143
Practice Address - Country:US
Practice Address - Phone:510-831-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2025-05-13
Deactivation Date:2021-01-25
Deactivation Code:
Reactivation Date:2025-05-13
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NV1231103TC0700X
CA35281103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist