Provider Demographics
NPI:1154603710
Name:LEVIN, LAURA B (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:LEVIN
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 1:3842 N SOUTHPORT AVE UNIT J
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6223
Mailing Address - Country:US
Mailing Address - Phone:847-477-1078
Mailing Address - Fax:
Practice Address - Street 1:3842 N SOUTHPORT AVE UNIT J
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6223
Practice Address - Country:US
Practice Address - Phone:847-477-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009746103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty