Healthcare Provider Details

I. General information

NPI: 1477600872
Provider Name (Legal Business Name): MONIQUE TERESA LEVY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE TERESA LEVY LCSW

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E DAKOTA AVE
FRESNO CA
93726-4804
US

IV. Provider business mailing address

2025 E DAKOTA AVE
FRESNO CA
93726-4804
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-5755
  • Fax: 559-453-4736
Mailing address:
  • Phone: 559-453-5755
  • Fax: 559-453-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS23360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: