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NPI Code Detail

MEDICARE: MRS. ELIZABETH R GARCIA-LEAVITT L.C.S.W.

MEDICARE:  MRS. ELIZABETH R GARCIA-LEAVITT  L.C.S.W.
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
11041C0700XClinical Social Worker5696385-3501UT

General Provider Information

NPI Number : 1912108515
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH R GARCIA-LEAVITT L.C.S.W.
Provider Business Mailing Address
First Line : 1331 E LUCK SPRING DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2947
Country : US
Telephone Number : 801-755-4574
Fax Number :
Provider Business Practice Location Address
First Line : 729 S ARAPEEN DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1218
Country : US
Telephone Number : 801-581-4771
Fax Number : 801-581-2483
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2007
Last Update Date : 11/01/2021

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