Healthcare Provider Details

I. General information

NPI: 1508417056
Provider Name (Legal Business Name): HANNAH GRACE ROSENBLATT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 N RAVENSWOOD AVE # 9
CHICAGO IL
60640-4478
US

IV. Provider business mailing address

1463 W BYRON ST APT 2D
CHICAGO IL
60613-2841
US

V. Phone/Fax

Practice location:
  • Phone: 203-641-4299
  • Fax:
Mailing address:
  • Phone: 203-641-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149020860
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: