Provider Demographics
NPI:1861428484
Name:LEVINSON, BRENT LEWIN (PHD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:LEWIN
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2225
Mailing Address - Country:US
Mailing Address - Phone:617-964-7654
Mailing Address - Fax:617-964-7654
Practice Address - Street 1:147 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-2225
Practice Address - Country:US
Practice Address - Phone:617-964-7654
Practice Address - Fax:617-964-7654
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA174OtherPSYCHOLOGY LICENSE
MAW01456OtherBLUE CROSS BLUE SHIELD
MA4456188OtherAETNA
MA174OtherPSYCHOLOGY LICENSE