| Sue Levy Psyd Lcsw Pa | |
|
3959 S Nova Road Bldg B Suite 23 Port Orange FL 32127-9229 | |
| (386) 253-8439 | |
| (386) 253-8439 |
| Full Name | Sue Levy Psyd Lcsw Pa |
|---|---|
| Speciality | Social Worker |
| Location | 3959 S Nova Road, Port Orange, Florida |
| Authorized Official Name and Position | Sue Levy (PRESIDENT/PSYCHOLOGIST) |
| Authorized Official Contact | 3862538439 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sue Levy Psyd Lcsw Pa 3959 S Nova Road Bldg B Suite 23 Port Orange FL 32127-9229 Ph: (386) 253-8439 | Sue Levy Psyd Lcsw Pa 3959 S Nova Road Bldg B Suite 23 Port Orange FL 32127-9229 Ph: (386) 253-8439 |
| NPI Number | 1124201983 |
|---|---|
| Provider Enumeration Date | 12/14/2007 |
| Last Update Date | 03/08/2022 |
| Certification Date | 03/08/2022 |
| Medicare PECOS PAC ID | 8224193487 |
|---|---|
| Medicare Enrollment ID | O20090223000389 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124201983 | NPI | - | NPPES |
| 1093747313 | Other | FL | INDIVIDUAL NPI |
| 768630700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW0002513 (Florida) | Primary |
| Provider Name | Sue Levy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093747313 PECOS PAC ID: 8325103583 Enrollment ID: I20090223000374 |
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