Provider Demographics
NPI:1457563546
Name:LEVY, SHARLA KAY
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:KAY
Last Name:LEVY
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 1:7120 N MILWAUKEE AVE
Mailing Address - Street 2:208
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4491
Mailing Address - Country:US
Mailing Address - Phone:847-588-2236
Mailing Address - Fax:
Practice Address - Street 1:5547 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1125
Practice Address - Country:US
Practice Address - Phone:773-769-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health