MEDICARE: ASYA BRODSKY 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	149.017085	IL

General Provider Information

NPI Number	:	1528321890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASYA BRODSKY LCSW

Provider Business Mailing Address
First Line	:	25 E WASHINGTON ST STE 1806
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST STE 1806
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1829
Country	:	US
Telephone Number	:	312-870-0885
Fax Number	:

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

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	01/09/2018

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