Provider Demographics
NPI:1528277019
Name:MYLES, DAVID LAWRENCE (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:MYLES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2145
Mailing Address - Country:US
Mailing Address - Phone:847-256-9805
Mailing Address - Fax:847-256-9807
Practice Address - Street 1:122 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-922-7474
Practice Address - Fax:312-922-5656
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical