Provider Demographics
NPI:1497175590
Name:LEAVITT, MAUREEN E (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:E
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:MARNIE
Other - Middle Name:E
Other - Last Name:LEAVITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:4158 SKYLINE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9723
Mailing Address - Country:US
Mailing Address - Phone:734-546-4811
Mailing Address - Fax:
Practice Address - Street 1:1100 VICTORS WAY STE 10
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5220
Practice Address - Country:US
Practice Address - Phone:734-973-6779
Practice Address - Fax:734-973-6609
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010805461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical