Healthcare Provider Details

I. General information

NPI: 1962808071
Provider Name (Legal Business Name): GRACE DUNLEVY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3063 ORLEANS DR
OXNARD CA
93036-5330
US

IV. Provider business mailing address

9909 LAS CRUCES ST
VENTURA CA
93004-2311
US

V. Phone/Fax

Practice location:
  • Phone: 909-831-5989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: