Healthcare Provider Details

I. General information

NPI: 1649370511
Provider Name (Legal Business Name): REBECCA LEVIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S WELLS ST SUITE 400 D
CHICAGO IL
60606-7106
US

IV. Provider business mailing address

7942 N ODELL AVE
NILES IL
60714-2933
US

V. Phone/Fax

Practice location:
  • Phone: 773-307-2864
  • Fax:
Mailing address:
  • Phone: 773-307-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-010523
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: