Provider Demographics
NPI:1730148404
Name:LEVETT, CAROL ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:LEVETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 STATE ROUTE 81
Mailing Address - Street 2:
Mailing Address - City:WEST COXSACKIE
Mailing Address - State:NY
Mailing Address - Zip Code:12192-1202
Mailing Address - Country:US
Mailing Address - Phone:518-755-7935
Mailing Address - Fax:518-751-1317
Practice Address - Street 1:104 STATE ROUTE 81
Practice Address - Street 2:
Practice Address - City:WEST COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12192-1202
Practice Address - Country:US
Practice Address - Phone:518-755-7935
Practice Address - Fax:518-751-1317
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005385-1103T00000X
NY005385-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16412OtherUBH
NY22657OtherBLUE SHIELD
NY960145OtherMVP
NY10029317OtherCDPHP
NY131588OtherVALUE OPTIONS
NY0040520OtherGHI
NY00555371Medicaid
NY142102000OtherMAGELLAN
NY16737OtherMHN