MEDICARE: JONATHAN LEVY LCSW LTD

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	149009106	IL

General Provider Information

NPI Number	:	1679628788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN LEVY LCSW LTD

Provider Business Mailing Address
First Line	:	1954 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2408
Country	:	US
Telephone Number	:	773-848-1219
Fax Number	:	773-832-9198

Provider Business Practice Location Address
First Line	:	1954 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2408
Country	:	US
Telephone Number	:	773-848-1219
Fax Number	:	773-832-9198

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JONATHAN ALAN LEVY
Credential	:	LCSW
Telephone Number	:	773-848-1219

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/04/2019

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