MEDICARE: WORTHSPACE PSYCHOTHERAPY, ASSESSMENT & CONSULTING

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	:	1144177114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORTHSPACE PSYCHOTHERAPY, ASSESSMENT & CONSULTING

Provider Business Mailing Address
First Line	:	4349 S ELLIS AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4762
Country	:	US
Telephone Number	:	708-505-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	4349 S ELLIS AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4762
Country	:	US
Telephone Number	:	708-505-9199
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MS. OLIVIA JONES
Credential	:	LCSW
Telephone Number	:	708-505-9199

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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