Provider Demographics
NPI:1841936200
Name:LOVELY, DAVID MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:LOVELY
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 1:7448 N DAMEN AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2258
Mailing Address - Country:US
Mailing Address - Phone:773-531-7107
Mailing Address - Fax:
Practice Address - Street 1:7448 N DAMEN AVE APT 1N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2258
Practice Address - Country:US
Practice Address - Phone:773-531-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490293451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149029345OtherILLINOIS DEPT. OF FINANCIAL & PROFESSIONAL REGULATION
IL150.108203OtherILLINOIS DEPT. OF FINANCIAL & PROFESSIONAL REGULATION