MEDICARE: DR. ERIC SETO PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071.008273	IL

General Provider Information

NPI Number	:	1407296502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC SETO PSY.D.

Provider Business Mailing Address
First Line	:	161 W HARRISON ST UNIT 1007
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1080
Country	:	US
Telephone Number	:	312-281-8874
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 N MICHIGAN AVE STE 1025G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7999
Country	:	US
Telephone Number	:	312-281-8874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	09/17/2020

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