Healthcare Provider Details

I. General information

NPI: 1922091776
Provider Name (Legal Business Name): NATASHA PETTY LEVERT PH.D, LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 ANNAPOLIS RD
ODENTON MD
21113-1216
US

IV. Provider business mailing address

1413 ANNAPOLIS RD
ODENTON MD
21113-1216
US

V. Phone/Fax

Practice location:
  • Phone: 410-882-1988
  • Fax: 707-982-0143
Mailing address:
  • Phone: 410-882-1988
  • Fax: 707-982-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCM188
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: