Provider Demographics
NPI:1669571105
Name:SEIDELMAN, KRISTINA (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SEIDELMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W LAKE ST
Mailing Address - Street 2:SUITE #404
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:708-930-1833
Mailing Address - Fax:708-445-9730
Practice Address - Street 1:1101 W LAKE ST
Practice Address - Street 2:SUITE #404
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-930-1833
Practice Address - Fax:708-445-9730
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker