Provider Demographics
NPI:1629196977
Name:LEV-ER, DEBORAH L (MSW LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:LEV-ER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 ANNADEL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8207
Mailing Address - Country:US
Mailing Address - Phone:414-248-1931
Mailing Address - Fax:707-571-8195
Practice Address - Street 1:3438 MENDOCINO AVE # B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2275
Practice Address - Country:US
Practice Address - Phone:707-387-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294121041C0700X
CALCS 294121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39721600Medicaid
WI39721600Medicaid
WIWI1041001Medicare PIN