Provider Demographics
NPI:1750034773
Name:NICOLE LEVINE THERAPY PLLC
Entity Type:Organization
Organization Name:NICOLE LEVINE THERAPY PLLC
Other - Org Name:NICOLE LEVINE THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:LEVINE-KAPKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:805-479-5867
Mailing Address - Street 1:230 E OHIO ST STE 4101232
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3265
Mailing Address - Country:US
Mailing Address - Phone:805-479-5867
Mailing Address - Fax:
Practice Address - Street 1:230 E OHIO ST STE 4101232
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3265
Practice Address - Country:US
Practice Address - Phone:805-479-5867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty