=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194020628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAH H. LEVI, PSY.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2011
-----------------------------------------------------
Last Update Date | 03/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 CHURCH ST SUITE 510
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-495-3639
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 636 CHURCH ST SUITE 510
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-495-3639
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SARAH H LEVI
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 773-495-3639
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 071007359
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------