Provider Demographics
NPI:1245551829
Name:LEVITAN, LAURA (SW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LEVITAN
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5752
Mailing Address - Country:US
Mailing Address - Phone:850-438-1136
Mailing Address - Fax:850-438-1148
Practice Address - Street 1:9400 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 109
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5752
Practice Address - Country:US
Practice Address - Phone:850-438-1136
Practice Address - Fax:850-438-1148
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW75021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical