Provider Demographics
NPI:1518307826
Name:SEABAUGH, DAVID EDWARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDWARD
Last Name:SEABAUGH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 W BALMORAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1809
Mailing Address - Country:US
Mailing Address - Phone:773-728-1170
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 1520
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6653
Practice Address - Country:US
Practice Address - Phone:312-257-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0087001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical