MEDICARE: EMILY ROSENBLOOM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1609520477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY ROSENBLOOM LCSW

Provider Business Mailing Address
First Line	:	3436 N BELL AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6002
Country	:	US
Telephone Number	:	520-338-6407
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 N BELL AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6002
Country	:	US
Telephone Number	:	520-338-6407
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST/BUSINESS OWNER
Name	:	EMILY ROSENBLOOM
Credential	:	LCSW
Telephone Number	:	520-338-6407

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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