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General NPI Number Information
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NPI Number | 1639386055
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Entity Type | Individual
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Provider Name | LEVENTE VON HEYDRICH PH.D, LLMSW, LBSW
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 4515 W SAGINAW HWY
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City | LANSING
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State | MI
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Zip | 48917-2740
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Country | US
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Telephone | 517-488-7018
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Fax |
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Provider Business Mailing Address
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Address Line | 6144 WORTHMORE AVE
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City | LANSING
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State | MI
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Zip | 48917-9209
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Country | US
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Telephone | 517-323-2713
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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 | 6802083653
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801085830
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License Number State | MI
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