Provider Demographics
NPI:1073688735
Name:LEVNER, MARY BAUMGARTNER (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BAUMGARTNER
Last Name:LEVNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-1918
Mailing Address - Country:US
Mailing Address - Phone:515-232-0518
Mailing Address - Fax:
Practice Address - Street 1:117 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-1918
Practice Address - Country:US
Practice Address - Phone:515-231-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040003451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical