Active NPI
Mimi Gordon-Levine, LCSW
- Clinical Social Worker
- Salt Lake City, UT
National Provider Identifier
1063485399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 941409633501
- Practice address
- 1141 E 3900 S
Ste A160
Salt Lake City, UT 84124-1215 - Phone
- (801) 264-2325
- NPI assigned
- Feb 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 941409633501 | UT | Primary |
Addresses
Primary practice location
1141 E 3900 S
Ste A160
Salt Lake City, UT 84124-1215
Mailing address
1141 E 3900 S
Ste A160
Salt Lake City, UT 84124-1215
Phone (801) 264-2325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 11, 2024 through Jul 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 941409633501 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1063485399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1141 E 3900 S",
"address_2": "STE A160",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841241215",
"telephone_number": "801-264-2325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1141 E 3900 S",
"address_2": "STE A160",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841241215",
"telephone_number": "801-264-2325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON-LEVINE",
"first_name": "MIMI",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-08",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "941409633501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.