Provider Demographics
NPI:1144522764
Name:LEAVITT, BETH (LICSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-2043
Mailing Address - Country:US
Mailing Address - Phone:507-931-8040
Mailing Address - Fax:507-931-8060
Practice Address - Street 1:116 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2043
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:507-931-8060
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical