Healthcare Provider Details

I. General information

NPI: 1740926120
Provider Name (Legal Business Name): LEVIN E MANABAT MSW, LCSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 THAR DESERT DR
CHAPARRAL NM
88081-7152
US

IV. Provider business mailing address

1405 THAR DESERT DR
CHAPARRAL NM
88081-7152
US

V. Phone/Fax

Practice location:
  • Phone: 971-381-8125
  • Fax: 971-600-9027
Mailing address:
  • Phone: 971-381-8125
  • Fax: 971-600-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0731
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11854
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: