Healthcare Provider Details

I. General information

NPI: 1285286500
Provider Name (Legal Business Name): GREGORY V DEKLEVER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 14TH ST
PORT TOWNSEND WA
98368-8503
US

IV. Provider business mailing address

1667 14TH ST
PORT TOWNSEND WA
98368-8503
US

V. Phone/Fax

Practice location:
  • Phone: 206-390-1474
  • Fax: 360-550-9508
Mailing address:
  • Phone: 206-390-1474
  • Fax: 360-550-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60461630
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: