Healthcare Provider Details

I. General information

NPI: 1619646304
Provider Name (Legal Business Name): NISHA KUMAR LEWONTIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2334 W LAWRENCE AVE STE 216
CHICAGO IL
60625-1033
US

IV. Provider business mailing address

2334 W LAWRENCE AVE STE 216
CHICAGO IL
60625-1033
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-8310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071010585
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: