Provider Demographics
NPI:1104975259
Name:POORVU, NANCY LEVITAN (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LEVITAN
Last Name:POORVU
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WELLS AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3302
Mailing Address - Country:US
Mailing Address - Phone:617-332-1601
Mailing Address - Fax:617-964-3040
Practice Address - Street 1:154 WELLS AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3302
Practice Address - Country:US
Practice Address - Phone:617-332-1601
Practice Address - Fax:617-964-3040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1048041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO P22045Medicare ID - Type UnspecifiedLICSW