Provider Demographics
NPI:1154471076
Name:LEVIS, MARY PATRICIA (MSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:LEVIS
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:FRAZIER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:93225-1083
Mailing Address - Country:US
Mailing Address - Phone:661-245-2617
Mailing Address - Fax:661-245-3181
Practice Address - Street 1:705 SAN EMIDIO WAY
Practice Address - Street 2:
Practice Address - City:FRAZIER PARK
Practice Address - State:CA
Practice Address - Zip Code:93225
Practice Address - Country:US
Practice Address - Phone:661-245-2617
Practice Address - Fax:661-245-3181
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical