Provider Demographics
NPI:1386928760
Name:LEVERICH, CLARISSA MAE (MS)
Entity type:Individual
Prefix:MISS
First Name:CLARISSA
Middle Name:MAE
Last Name:LEVERICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MILL ST
Mailing Address - Street 2:SUITE 251
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4598
Mailing Address - Country:US
Mailing Address - Phone:413-568-6141
Mailing Address - Fax:
Practice Address - Street 1:77 MILL ST
Practice Address - Street 2:SUITE 251
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4598
Practice Address - Country:US
Practice Address - Phone:413-568-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid