Provider Demographics
NPI:1699460758
Name:LEVENBERRY, CIARA
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:LEVENBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 37TH PL SE APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3226
Mailing Address - Country:US
Mailing Address - Phone:202-520-4532
Mailing Address - Fax:
Practice Address - Street 1:1949 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1211
Practice Address - Country:US
Practice Address - Phone:202-462-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder