MEDICARE: MR. ALEXANDER TAYLOR LEVERTY LCSW

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
1	1041C0700X	Clinical Social Worker	0904004547	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	306836	OTHER	VA	BC/BS
2	089781	OTHER		SENTARA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	507248	OTHER	VA	VALUE OPTION

General Provider Information

NPI Number	:	1780679027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER TAYLOR LEVERTY LCSW

Provider Business Mailing Address
First Line	:	9020 STONY POINT PKWY
Second Line	:	STE 240
City	:	RICHMOND
State	:	VA
Zip	:	23235
Country	:	US
Telephone Number	:	804-282-5236
Fax Number	:	804-282-5547

Provider Business Practice Location Address
First Line	:	9020 STONY POINT PKWY
Second Line	:	STE 240
City	:	RICHMOND
State	:	VA
Zip	:	23235
Country	:	US
Telephone Number	:	804-282-5236
Fax Number	:	804-282-5547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/18/2013

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Directions to “ MR. ALEXANDER TAYLOR LEVERTY LCSW” Practice Location

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