Provider Demographics
NPI:1912441908
Name:LEVY, MOLLYE (PSYD)
Entity Type:Individual
Prefix:
First Name:MOLLYE
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W WELLINGTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7187
Mailing Address - Country:US
Mailing Address - Phone:312-384-1940
Mailing Address - Fax:773-423-8444
Practice Address - Street 1:1011 W WELLINGTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7187
Practice Address - Country:US
Practice Address - Phone:312-384-1940
Practice Address - Fax:773-423-8444
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical