=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497981559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | N.A. LEVY MD & ASSOC, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2009
-----------------------------------------------------
Last Update Date | 12/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 W. LAKE STREET SUITE 418
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-386-4517
-----------------------------------------------------
Fax | 708-386-4490
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1011 W. LAKE STREET SUITE 418
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-386-4517
-----------------------------------------------------
Fax | 708-386-4490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NAOMI ADINA LEVY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 708-386-4517
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 036-096478
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------