Jack Sanford Levine, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY6826 Issued in CA

Practice address

750 Terrado PLZ
Suite 246
Covina, CA 91723-3419

Phone

(626) 915-0933

Fax

(626) 339-2885

NPI assigned

Feb 22, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Direct Outlook Psychological Services Inc.

  • Clinical Psychologist
  • Covina, CA
  • NPI 1033750617
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437284239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 TERRADO PLZ",
            "address_2": "SUITE 246",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917233419",
            "telephone_number": "626-915-0933",
            "fax_number": "626-339-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 TERRADO PLZ",
            "address_2": "SUITE 246",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917233419",
            "telephone_number": "626-915-0933",
            "fax_number": "626-339-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVINE",
        "first_name": "JACK",
        "middle_name": "SANFORD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY6826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheyenne Lesko
• Edmund Lestari, RPH
• Christina Darlene Leung, O.D.
• Jonathan K Leung, MD
• Zachary Robert Levin
• Debra Levray
• Kendra Mae Lewin, MS, ATC
• Lanisha Lewis
• Latasha Lee Lewis
• Brian Christopher Lewison

• Clinical Psychologist in Covina, CA
• Providers in Covina, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.