Provider Demographics
NPI:1821240383
Name:LEVINE, MELANIE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:S
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N MICHIGAN AVE STE 560
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7799
Mailing Address - Country:US
Mailing Address - Phone:773-413-8394
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 560
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7799
Practice Address - Country:US
Practice Address - Phone:773-413-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015536-1103TC0700X
IL071.008357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical