Healthcare Provider Details

I. General information

NPI: 1790002699
Provider Name (Legal Business Name): BLANCHE LEVERE PH.D, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2010
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W STATE ST SUITE #2
TRENTON NJ
08618-5704
US

IV. Provider business mailing address

PO BOX 2972
PRINCETON NJ
08543-2972
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-0401
  • Fax: 609-394-0045
Mailing address:
  • Phone: 609-394-0401
  • Fax: 609-394-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT000109
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLCPC064-3684
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: