MEDICARE: LEORA LEVINE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6383-C	NV

General Provider Information

NPI Number	:	1801133392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEORA LEVINE LCSW

Provider Business Mailing Address
First Line	:	4794 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6145
Country	:	US
Telephone Number	:	702-732-0304
Fax Number	:

Provider Business Practice Location Address
First Line	:	4794 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6145
Country	:	US
Telephone Number	:	702-732-0304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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