Healthcare Provider Details

I. General information

NPI: 1184985988
Provider Name (Legal Business Name): REBECCA ROSE LEVERETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E WARDLOW RD
LONG BEACH CA
90807-4630
US

IV. Provider business mailing address

900 E WARDLOW RD
LONG BEACH CA
90807-4630
US

V. Phone/Fax

Practice location:
  • Phone: 801-644-4914
  • Fax:
Mailing address:
  • Phone: 801-644-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNONE
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: