MEDICARE: SUSANA ORTEGA 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	149014087	IL

General Provider Information

NPI Number	:	1578111845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA ORTEGA LCSW

Provider Business Mailing Address
First Line	:	3058 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5707
Country	:	US
Telephone Number	:	312-927-3726
Fax Number	:

Provider Business Practice Location Address
First Line	:	3058 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5707
Country	:	US
Telephone Number	:	312-927-3726
Fax Number	:

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

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/14/2023

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Directions to “ SUSANA ORTEGA LCSW” Practice Location

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