MEDICARE: MRS. DANA J LIVSEY 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	001912	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932193109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA J LIVSEY LCSW

Provider Business Mailing Address
First Line	:	1300 E BRADFORD PKWY
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4264
Country	:	US
Telephone Number	:	417-761-5000
Fax Number	:	417-761-5065

Provider Business Practice Location Address
First Line	:	305 N MASON ST
Second Line	:
City	:	CARROLLTON
State	:	MO
Zip	:	64633-2247
Country	:	US
Telephone Number	:	660-542-1403
Fax Number	:

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	12/21/2022

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