Provider Demographics
NPI:1205495678
Name:LEAVITT, KATHRYN MARIE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:MARIE
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 JEWETT PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2322
Mailing Address - Country:US
Mailing Address - Phone:716-581-0137
Mailing Address - Fax:
Practice Address - Street 1:70 JEWETT PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2322
Practice Address - Country:US
Practice Address - Phone:716-581-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096547104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY096547OtherLMSW