Provider Demographics
NPI:1346963386
Name:LEVIN, LONNY
Entity Type:Individual
Prefix:
First Name:LONNY
Middle Name:
Last Name:LEVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 EWING AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1708
Mailing Address - Country:US
Mailing Address - Phone:847-852-6896
Mailing Address - Fax:
Practice Address - Street 1:1007 CHURCH ST STE 312
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5912
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health