Provider Demographics
NPI:1821190323
Name:LEVERENZ, CANDACE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:ELIZABETH
Last Name:LEVERENZ
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 1:403 E ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-2424
Mailing Address - Country:US
Mailing Address - Phone:217-497-8506
Mailing Address - Fax:217-443-4727
Practice Address - Street 1:918 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3965
Practice Address - Country:US
Practice Address - Phone:217-443-1400
Practice Address - Fax:217-443-4727
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20692901041S0200X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL265517OtherCOMPSYCH
ILK15775Medicare ID - Type Unspecified