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General NPI Number Information
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NPI Number | 1528192556
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Entity Type | Individual
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Provider Name | RENA GOODFRIEND-LEVE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 545 LINCOLN AVE STE 4
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City | WINNETKA
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State | IL
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Zip | 60093-2349
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Country | US
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Telephone | 847-604-0564
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE DEPT OF PSYCHIATRY
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City | EVANSTON
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State | IL
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Zip | 60201-1718
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Country | US
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Telephone | 847-570-2050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036087904
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License Number State | IL
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