Healthcare Provider Details

I. General information

NPI: 1093388076
Provider Name (Legal Business Name): JOSEPHINA CATHERINE LEVERONI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CAMINO DEL RIO S STE 201
SAN DIEGO CA
92108-3505
US

IV. Provider business mailing address

409 CAMINO DEL RIO S STE 201
SAN DIEGO CA
92108-3505
US

V. Phone/Fax

Practice location:
  • Phone: 619-381-7748
  • Fax:
Mailing address:
  • Phone: 619-381-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number224926
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: