Individual provider Active NPI

Debra Suzanne Leavitt, LICSW

  • Clinical Social Worker
  • Golden Valley, MN
National Provider Identifier
1972742393
Registry record updated Feb 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
17629 Issued in MN
Practice address
8401 Wayzata Blvd Ste 370
Golden Valley, MN 55426-1379
Phone
(763) 544-1006
Fax
(763) 544-1008
NPI assigned
Feb 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 17629 MN Primary

Addresses

Primary practice location

8401 Wayzata Blvd Ste 370
Golden Valley, MN 55426-1379

Mailing address

8401 Wayzata Blvd Ste 370
Golden Valley, MN 55426-1379
Phone (763) 544-1006

Other identifiers 1

IdentifierTypeStateIssuer
17629OtherMNLICSW STATE BOARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
17629MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hoy & Associates Inc. Past Accepting new patients

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": "1234137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234137600000",
    "number": "1972742393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 WAYZATA BLVD STE 370",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261379",
            "telephone_number": "763-544-1006",
            "fax_number": "763-544-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 WAYZATA BLVD STE 370",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261379",
            "telephone_number": "763-544-1006",
            "fax_number": "763-544-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAVITT",
        "first_name": "DEBRA",
        "middle_name": "SUZANNE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-09",
        "last_updated": "2009-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "17629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICSW STATE BOARD",
            "identifier": "17629",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.