Healthcare Provider Details

I. General information

NPI: 1356900609
Provider Name (Legal Business Name): LEVARINE GRAHAM LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 SUNFOREST CT STE 265
TOLEDO OH
43623-4485
US

IV. Provider business mailing address

4212 PACKARD RD
TOLEDO OH
43612-1940
US

V. Phone/Fax

Practice location:
  • Phone: 419-407-6092
  • Fax: 419-839-2925
Mailing address:
  • Phone: 419-280-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608381
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: