1720320302 NPI number — MR. DAVID MICHAEL LEVERT LCSW-C

Table of content: MR. DAVID MICHAEL LEVERT LCSW-C (NPI 1720320302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720320302 NPI number — MR. DAVID MICHAEL LEVERT LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVERT
Provider First Name:
DAVID
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720320302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4985 LORDS CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21822-2279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-366-0259
Provider Business Mailing Address Fax Number:
410-219-2666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-5352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-366-0259
Provider Business Practice Location Address Fax Number:
410-219-2666
Provider Enumeration Date:
03/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  10303 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 064633400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com