MEDICARE: MORGAN LEVY

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1972154920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN LEVY

Provider Business Mailing Address
First Line	:	71 W HUBBARD ST APT 3006
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6860 N FRONTAGE RD UNIT A
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-7828
Country	:	US
Telephone Number	:	331-210-9210
Fax Number	:

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

Provider Enumeration Date	:	09/21/2019
Last Update Date	:	11/14/2022

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