=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720320302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID MICHAEL LEVERT LCSW-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2013
-----------------------------------------------------
Last Update Date | 05/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 RIVERSIDE DR SUITE 7
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-5352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-366-0259
-----------------------------------------------------
Fax | 410-219-2666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4985 LORDS CREEK DR
-----------------------------------------------------
City | EDEN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21822-2279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-366-0259
-----------------------------------------------------
Fax | 410-219-2666
-----------------------------------------------------
=====================================================
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 | 10303
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------