Provider Demographics
NPI:1124374608
Name:LEVEILLE, VANESSA AMADO (LICSW)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:AMADO
Last Name:LEVEILLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WARREN ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3259
Mailing Address - Country:US
Mailing Address - Phone:617-286-6861
Mailing Address - Fax:
Practice Address - Street 1:100 WARREN ST STE 1A
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-3259
Practice Address - Country:US
Practice Address - Phone:617-286-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1195311041C0700X
MA2186581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical