Provider Demographics
NPI:1063205086
Name:BLESOFSKY, LEVI ISAAC (ACSW)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:ISAAC
Last Name:BLESOFSKY
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19791 LOMBARDY LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2818
Mailing Address - Country:US
Mailing Address - Phone:714-809-3989
Mailing Address - Fax:
Practice Address - Street 1:19791 LOMBARDY LN
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2818
Practice Address - Country:US
Practice Address - Phone:714-809-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW101671104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker