Provider Demographics
NPI:1952499980
Name:LEAVITT, HARVEY MICHAEL (MSW)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:MICHAEL
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E. NOB HILL BLVD.
Mailing Address - Street 2:
Mailing Address - City:YAKOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-3534
Mailing Address - Country:US
Mailing Address - Phone:509-248-3334
Mailing Address - Fax:
Practice Address - Street 1:602 E NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-3534
Practice Address - Country:US
Practice Address - Phone:509-248-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2025690Medicaid