Healthcare Provider Details

I. General information

NPI: 1669452827
Provider Name (Legal Business Name): PAUL T LEVERINGTON L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 E BENNETT ST
SPRINGFIELD MO
65804-1419
US

IV. Provider business mailing address

1239 E PORTLAND ST
SPRINGFIELD MO
65804-1125
US

V. Phone/Fax

Practice location:
  • Phone: 417-885-9940
  • Fax:
Mailing address:
  • Phone: 417-885-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003690
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: