Ethan R. Levine, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

650 Issued in NC

Legal business name

ETHAN R. LEVINE, PH.D.

Practice address

11937 Straight a Way LN
Raleigh, NC 27613-7105

Phone

(919) 264-3755

Fax

(919) 846-9231

NPI assigned

Feb 5, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Ethan Roy Levine, PH.D.NPI 1538300025

Title

Managing Director

Phone

(919) 264-3755

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ethan R Levine, PH.D.

  • Adult Development & Aging Psychologist
  • Concord, NC
  • NPI 1538300025

  Clinical

  NPD Authorized official

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

{
    "created_epoch": "1517788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517788800000",
    "number": "1972002004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11937 STRAIGHT A WAY LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276137105",
            "telephone_number": "919-264-3755",
            "fax_number": "919-846-9231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11937 STRAIGHT A WAY LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276137105",
            "telephone_number": "919-264-3755",
            "fax_number": "919-846-9231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHAN R. LEVINE, PH.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-05",
        "last_updated": "2018-02-05",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "919-264-3755",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany L Estep, FNP
• Sonja P Estes, RPH
• Jesus Lemuel Estrada, DC
• Kaye Estrada
• Estrella Rehabilitation and Support Services Inc
• Terry Ether, C.P.O.
• Amelia Etheridge
• William Thomas Gordon Etheridge
• Erica Etienne
• Nicanor Etienne

• Clinical Psychologist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.