Provider Demographics
NPI:1497875637
Name:LAUERLEVIN, MINDY (LCSW)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LAUERLEVIN
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 1:1745 W ORANGEWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:714-633-7766
Practice Address - Street 1:1745 W ORANGEWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2041
Practice Address - Country:US
Practice Address - Phone:714-301-4544
Practice Address - Fax:714-633-7766
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALIC 198381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical