Individual provider Active NPI

Vanessa Amado Leveille, LICSW

  • Clinical Social Worker
  • Roxbury, MA
National Provider Identifier
1124374608
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
119531 Issued in MA
Practice address
100 Warren St Ste 1a
Roxbury, MA 02119-3259
Phone
(617) 286-6861
NPI assigned
Aug 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 119531 MA Primary
Clinical Social Worker 1041C0700X 218658 MA

Addresses

Primary practice location

100 Warren St Ste 1a
Roxbury, MA 02119-3259

Mailing address

100 Warren St Ste 1a
Roxbury, MA 02119-3259
Phone (617) 286-6861

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
119531MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Holistically You, Inc. Clinical CurrentSince Jul 25, 2021 Accepting new patients

Locations

100 Warren St
Ste 1A
Roxbury, MA 02119
Phone (617) 286-6861

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1124374608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WARREN ST STE 1A",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021193259",
            "telephone_number": "617-286-6861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WARREN ST STE 1A",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021193259",
            "telephone_number": "617-286-6861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVEILLE",
        "first_name": "VANESSA",
        "middle_name": "AMADO",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-02",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "119531",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "218658",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roxbury, MA

Sources for this page

Verify at the official NPI Registry.