Provider Demographics
NPI:1538288634
Name:MARY BAUMGARTNER LEVNER LCSW PLLC
Entity Type:Organization
Organization Name:MARY BAUMGARTNER LEVNER LCSW PLLC
Other - Org Name:MARY B LEVNER LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BAUMGARTNER
Authorized Official - Last Name:LEVNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:515-231-8118
Mailing Address - Street 1:117 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-1918
Mailing Address - Country:US
Mailing Address - Phone:515-231-8118
Mailing Address - Fax:757-424-5623
Practice Address - Street 1:6477 COLLEGE PARK SQ
Practice Address - Street 2:SUITE 302
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3611
Practice Address - Country:US
Practice Address - Phone:757-424-0100
Practice Address - Fax:757-424-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090003451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty