MEDICARE: EMILY LAUREN BECK 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	149017978	IL

General Provider Information

NPI Number	:	1598215212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY LAUREN BECK LCSW

Provider Business Mailing Address
First Line	:	3111 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3818
Country	:	US
Telephone Number	:	872-216-6024
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4002
Country	:	US
Telephone Number	:	872-216-6024
Fax Number	:

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

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	05/09/2019

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