1538288634 NPI number — MARY BAUMGARTNER LEVNER LCSW PLLC

Table of content: (NPI 1538288634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538288634 NPI number — MARY BAUMGARTNER LEVNER LCSW PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY BAUMGARTNER LEVNER LCSW PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARY B LEVNER LCSW
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538288634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 RIVERVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23704-1918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-231-8118
Provider Business Mailing Address Fax Number:
757-424-5623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6477 COLLEGE PARK SQ
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23464-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-424-0100
Provider Business Practice Location Address Fax Number:
757-424-5623
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVNER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
BAUMGARTNER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
515-231-8118

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  09000345 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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