MEDICARE: MRS. CARLA B LEVIN LCSW RCD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1671188	OTHER	IL	BLUE CROSS BLUE SHIELD
2	10127	OTHER	IL	AMERICAN BOARD OF EXAM

General Provider Information

NPI Number	:	1376653485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLA B LEVIN LCSW RCD

Provider Business Mailing Address
First Line	:	2912 N COMMONWEALTH AVE
Second Line	:	#9
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	312-372-3574
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 E WASHINGTON ST
Second Line	:	SUITE 1719
City	:	CHICAGO
State	:	IL
Zip	:	60602-2439
Country	:	US
Telephone Number	:	312-372-3574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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