Healthcare Provider Details

I. General information

NPI: 1578595807
Provider Name (Legal Business Name): LYNN MARIE LEVIN M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RENAISSANCE DR STE 320
PARK RIDGE IL
60068-1471
US

IV. Provider business mailing address

9560 GROSS POINT RD APT 507B
SKOKIE IL
60076-4303
US

V. Phone/Fax

Practice location:
  • Phone: 847-759-9110
  • Fax:
Mailing address:
  • Phone: 248-330-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801014151
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801014151
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: