Provider Demographics
NPI:1447259460
Name:LEVIN, CLIFFORD A (PHD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:A
Last Name:LEVIN
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 1:1212 NW 12TH AVE
Mailing Address - Street 2:STE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3032
Mailing Address - Country:US
Mailing Address - Phone:352-372-6645
Mailing Address - Fax:352-373-1237
Practice Address - Street 1:1212 NW 12TH AVE
Practice Address - Street 2:STE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3032
Practice Address - Country:US
Practice Address - Phone:352-372-6645
Practice Address - Fax:352-373-1237
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003922103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73186OtherBCBS
FL73186ZMedicare ID - Type Unspecified