Healthcare Provider Details

I. General information

NPI: 1073646592
Provider Name (Legal Business Name): AMY BROITMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 W GRANVILLE AVE APT 3
CHICAGO IL
60660-5093
US

IV. Provider business mailing address

1346 W GRANVILLE AVE APT 3
CHICAGO IL
60660-5093
US

V. Phone/Fax

Practice location:
  • Phone: 847-508-4842
  • Fax:
Mailing address:
  • Phone: 847-508-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-003274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: