Provider Demographics
NPI:1033646542
Name:LEVITT, FREDI RUTH
Entity type:Individual
Prefix:
First Name:FREDI
Middle Name:RUTH
Last Name:LEVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:FREDI
Other - Middle Name:RUTH
Other - Last Name:LEVITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6530 LA CONTENTA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-7313
Mailing Address - Country:US
Mailing Address - Phone:760-820-9229
Mailing Address - Fax:
Practice Address - Street 1:58383 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5890
Practice Address - Country:US
Practice Address - Phone:760-365-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW123271041C0700X
CA1262211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical