Provider Demographics
NPI:1497306609
Name:AVILES, SEBASTINO (LCSW, MPH)
Entity Type:Individual
Prefix:
First Name:SEBASTINO
Middle Name:
Last Name:AVILES
Suffix:
Gender:M
Credentials:LCSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N WABASH AVE STE 1203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3095
Mailing Address - Country:US
Mailing Address - Phone:312-513-3746
Mailing Address - Fax:312-264-0659
Practice Address - Street 1:111 N WABASH AVE STE 1203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3095
Practice Address - Country:US
Practice Address - Phone:312-513-3746
Practice Address - Fax:312-264-0659
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0212131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical