Provider Demographics
NPI:1720962525
Name:LEVENDOSKY, SIMONE
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:
Last Name:LEVENDOSKY
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 1:10114 S FULTON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-0260
Mailing Address - Country:US
Mailing Address - Phone:505-550-7939
Mailing Address - Fax:
Practice Address - Street 1:3412 MASSAPONAX CHURCH RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-8778
Practice Address - Country:US
Practice Address - Phone:540-834-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool