Provider Demographics
NPI:1376653485
Name:LEVIN, CARLA B (LCSW RCD)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:B
Last Name:LEVIN
Suffix:
Gender:F
Credentials:LCSW RCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 N COMMONWEALTH AVE
Mailing Address - Street 2:#9
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:312-372-3574
Mailing Address - Fax:
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 1719
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2439
Practice Address - Country:US
Practice Address - Phone:312-372-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1671188OtherBLUE CROSS BLUE SHIELD
IL10127OtherAMERICAN BOARD OF EXAM