=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437282985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBYN KAPLAN SEIDMAN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 02/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1623 N WESTERN AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60647-5321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-446-5520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 826 FOREST AVE
-----------------------------------------------------
City | RIVER FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60305-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-752-0867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149-008792
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------