Provider Demographics
NPI:1083927198
Name:LEAVITT, JUDYTH A (LICSW, MLADC)
Entity Type:Individual
Prefix:
First Name:JUDYTH
Middle Name:A
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:LICSW, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 MARCY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SWANZEY
Mailing Address - State:NH
Mailing Address - Zip Code:03446-2108
Mailing Address - Country:US
Mailing Address - Phone:603-448-2705
Mailing Address - Fax:
Practice Address - Street 1:172 MARCY HILL RD
Practice Address - Street 2:
Practice Address - City:SWANZEY
Practice Address - State:NH
Practice Address - Zip Code:03446-2108
Practice Address - Country:US
Practice Address - Phone:603-448-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0631101YA0400X
NH15141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)