Provider Demographics
NPI:1619600665
Name:SHABSIN, SAMUEL (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SHABSIN
Suffix:
Gender:M
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 N LINCOLN PARK W APT 8D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4621
Mailing Address - Country:US
Mailing Address - Phone:314-520-8081
Mailing Address - Fax:
Practice Address - Street 1:2000 N RACINE AVE STE 3300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7008
Practice Address - Country:US
Practice Address - Phone:312-439-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501083061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical