Provider Demographics
NPI:1598224180
Name:LEVEILLE, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LEVEILLE
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 1:505 NW RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8619
Mailing Address - Country:US
Mailing Address - Phone:772-501-1059
Mailing Address - Fax:
Practice Address - Street 1:505 NW RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8619
Practice Address - Country:US
Practice Address - Phone:772-501-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker