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General NPI Number Information
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NPI Number | 1528156056
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Entity Type | Individual
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Provider Name | CHARLES GEORGE LEVENTIS M.ED LADC1
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 27 CONGRESS ST 105
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City | SALEM
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State | MA
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Zip | 01970-7309
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Country | US
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Telephone | 978-700-1570
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Fax | 978-741-1304
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Provider Business Mailing Address
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Address Line | 14 CIRCLE DR
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City | SANFORD
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State | ME
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Zip | 04073-2402
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Country | US
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Telephone | 978-740-1570
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Fax | 978-741-1304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 227
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License Number State | MA
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