Active NPI
Mark D Levine, M.S.
- Behavior Analyst
- San Rafael, CA
National Provider Identifier
1760610653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-00-0276
- Practice address
- 454 Las Gallinas Ave
Suite 131
San Rafael, CA 94903-3618 - Phone
- (415) 297-9190
- NPI assigned
- Jun 30, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 27 | HI | |
| Professional Counselor | 101YP2500X | 2935 | NC | |
| Behavior Analyst | 103K00000X | 1-00-0276 | Primary |
Addresses
Primary practice location
454 Las Gallinas Ave
Suite 131
San Rafael, CA 94903-3618
Mailing address
454 Las Gallinas Ave
Suite 131
San Rafael, CA 94903-3618
Phone (415) 297-9190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2935 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246320000000",
"number": "1760610653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "454 LAS GALLINAS AVE",
"address_2": "SUITE 131",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949033618",
"telephone_number": "415-297-9190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "454 LAS GALLINAS AVE",
"address_2": "SUITE 131",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949033618",
"telephone_number": "415-297-9190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEVINE",
"first_name": "MARK",
"middle_name": "D",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-30",
"last_updated": "2009-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "HI",
"license": "27",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "2935",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "1-00-0276",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.