Provider Demographics
NPI:1326643024
Name:LEVINSON, LEILA
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4319
Mailing Address - Country:US
Mailing Address - Phone:512-417-0845
Mailing Address - Fax:
Practice Address - Street 1:4807 SPICEWOOD SPRINGS RD BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8444
Practice Address - Country:US
Practice Address - Phone:512-843-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker