Provider Demographics
NPI:1801193131
Name:JOANNE KACHMAR LEAVITT, LCSW
Entity Type:Organization
Organization Name:JOANNE KACHMAR LEAVITT, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:KACHMAR
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:561-968-8361
Mailing Address - Street 1:7120 BOBALINK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1305
Mailing Address - Country:US
Mailing Address - Phone:561-968-8361
Mailing Address - Fax:
Practice Address - Street 1:7120 BOBALINK CT
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1305
Practice Address - Country:US
Practice Address - Phone:561-968-8361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW2509305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization