Provider Demographics
NPI:1376026609
Name:LEVINE, JENNIFER (LCPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15515 W SUNSET BLVD UNIT 117
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3530
Mailing Address - Country:US
Mailing Address - Phone:310-428-0232
Mailing Address - Fax:310-388-4678
Practice Address - Street 1:15515 W SUNSET BLVD UNIT 117
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3530
Practice Address - Country:US
Practice Address - Phone:310-428-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014134101YM0800X
IL180.13717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health