Basic Information
| Provider Information | |||||||||
| NPI: | 1518574458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEAVITT | ||||||||
| FirstName: | NOAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | SWT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24650 HILLTOP DR | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441221346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149549803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22001 FAIRMOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441184897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169322800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2020 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.2001475-TRNE | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.