Provider Demographics
NPI:1679628788
Name:JONATHAN LEVY LCSW LTD
Entity Type:Organization
Organization Name:JONATHAN LEVY LCSW LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-848-1219
Mailing Address - Street 1:1954 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2408
Mailing Address - Country:US
Mailing Address - Phone:773-848-1219
Mailing Address - Fax:773-832-9198
Practice Address - Street 1:1954 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2408
Practice Address - Country:US
Practice Address - Phone:773-848-1219
Practice Address - Fax:773-832-9198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONATHAN LEVY LCSW LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490091061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210074Medicare PIN