Provider Demographics
NPI:1710760715
Name:LEVINE, EMILY FITZGERALD
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:FITZGERALD
Last Name:LEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 N SAWYER AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2754
Mailing Address - Country:US
Mailing Address - Phone:610-608-2019
Mailing Address - Fax:
Practice Address - Street 1:3711 N RAVENSWOOD AVE STE 146
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5944
Practice Address - Country:US
Practice Address - Phone:773-274-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health