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General NPI Number Information
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NPI Number | 1558591446
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Entity Type | Individual
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Provider Name | DEBRA A LEVACK LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/26/2009
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1248 PIROS DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-1135
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Country | US
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Telephone | 719-573-7837
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Fax |
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Provider Business Mailing Address
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Address Line | 3014 ESCAPARDO CIR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-3343
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Country | US
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Telephone | 719-310-0254
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 992653
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License Number State | CO
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