MEDICARE: MS. MICHELE BETH WILLIAMS 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	149003918	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	01671406	OTHER	BLUE CROSS
2	088458	OTHER	MHN
3	093823000	OTHER	MAGELLAN
4	140093	OTHER	VALUE OPTIONS

General Provider Information

NPI Number	:	1538225453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE BETH WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	2326 N LINCOLN PARK WEST
Second Line	:	#3C
City	:	CHICAGO
State	:	IL
Zip	:	60614
Country	:	US
Telephone Number	:	773-404-0480
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 N MICHIGAN AVE
Second Line	:	STE 329
City	:	CHICAGO
State	:	IL
Zip	:	60601-7511
Country	:	US
Telephone Number	:	773-404-0480
Fax Number	:

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	11/01/2021

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