Provider Demographics
NPI:1700950029
Name:LEVINE, VIRGINIA G (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:G
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:GALLOGLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1212 NORTH LAKE SHORE DRIVE
Mailing Address - Street 2:APT #5C SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6670
Mailing Address - Country:US
Mailing Address - Phone:312-266-8908
Mailing Address - Fax:312-266-8908
Practice Address - Street 1:1212 NORTH LAKE SHORE DRIVE
Practice Address - Street 2:APT #5C SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6670
Practice Address - Country:US
Practice Address - Phone:312-266-8908
Practice Address - Fax:312-266-8908
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical