MEDICARE: SAMEENA ANSARI 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	149027475	IL

General Provider Information

NPI Number	:	1184106338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMEENA ANSARI LCSW

Provider Business Mailing Address
First Line	:	5100 N MARINE DR APT 11D
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-6357
Country	:	US
Telephone Number	:	630-202-9881
Fax Number	:

Provider Business Practice Location Address
First Line	:	5642 W DIVERSEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1353
Country	:	US
Telephone Number	:	708-465-1293
Fax Number	:

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

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	01/27/2026

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