=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003282872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY LEVIS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2015
-----------------------------------------------------
Last Update Date | 08/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31432 WATERS WAY
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-690-4021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17021 OLD ORCHARD RD SUITE 4
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-4832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-703-6225
-----------------------------------------------------
Fax | 302-827-4856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | Q1-0000944
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------