Provider Demographics
NPI:1114095460
Name:LEAVITT, BETSY A (MSW)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:A
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BOSTON HARBOR ROAD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4645
Mailing Address - Country:US
Mailing Address - Phone:603-749-0558
Mailing Address - Fax:603-742-9523
Practice Address - Street 1:11 BOSTON HARBOR RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4645
Practice Address - Country:US
Practice Address - Phone:603-749-0558
Practice Address - Fax:603-742-9523
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical