Provider Demographics
NPI:1427827617
Name:SHABAT, YEDIDYA (LPC, CADC)
Entity type:Individual
Prefix:
First Name:YEDIDYA
Middle Name:
Last Name:SHABAT
Suffix:
Gender:M
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 N KEDZIE AVE APT 815
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5809
Mailing Address - Country:US
Mailing Address - Phone:773-895-6261
Mailing Address - Fax:
Practice Address - Street 1:3557 W PETERSON AVE STE 122
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3218
Practice Address - Country:US
Practice Address - Phone:773-478-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34740101YA0400X
IL178.018434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)