MEDICARE: MELANIE MARIE OBROCHTA 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	149.019239	IL

General Provider Information

NPI Number	:	1023858479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE MARIE OBROCHTA LCSW

Provider Business Mailing Address
First Line	:	676 N SAINT CLAIR ST FL 7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2927
Country	:	US
Telephone Number	:	312-695-7970
Fax Number	:	312-695-4433

Provider Business Practice Location Address
First Line	:	676 N SAINT CLAIR ST FL 7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2927
Country	:	US
Telephone Number	:	312-695-7970
Fax Number	:	312-695-4433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	04/03/2026

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