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NPI Code Detail

MEDICARE: JIRMIAH LEVERETTE MSW

MEDICARE: JIRMIAH LEVERETTE MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker150.105846IL

General Provider Information

NPI Number : 1124760426
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIRMIAH LEVERETTE MSW
Provider Business Mailing Address
First Line : 480 N MCCLURG CT APT 513
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5337
Country : US
Telephone Number : 312-955-0319
Fax Number :
Provider Business Practice Location Address
First Line : 480 N MCCLURG CT APT 513
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5337
Country : US
Telephone Number : 312-955-0319
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2022
Last Update Date : 04/08/2022

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