Provider Demographics
NPI:1275109001
Name:LEVENTIS, GEORGETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:
Last Name:LEVENTIS
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 1:1510 S 1400 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2626
Mailing Address - Country:US
Mailing Address - Phone:801-230-5634
Mailing Address - Fax:
Practice Address - Street 1:1510 S 1400 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2626
Practice Address - Country:US
Practice Address - Phone:801-230-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT378061-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical