MEDICARE: AMY BROITMAN 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	149-003274	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149-003274	OTHER	IL	LCSW

General Provider Information

NPI Number	:	1073646592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BROITMAN LCSW

Provider Business Mailing Address
First Line	:	1346 W GRANVILLE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-5093
Country	:	US
Telephone Number	:	847-508-4842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 W GRANVILLE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-5093
Country	:	US
Telephone Number	:	847-508-4842
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/05/2026

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Directions to “ AMY BROITMAN LCSW” Practice Location

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