MEDICARE: REBECCA SOLOMON 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	149010961	IL

General Provider Information

NPI Number	:	1720249865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA SOLOMON LCSW

Provider Business Mailing Address
First Line	:	1059 N WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3238
Country	:	US
Telephone Number	:	312-925-4169
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 QUEENS BLVD
Second Line	:	SUITE 1403
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7200
Country	:	US
Telephone Number	:	781-268-6600
Fax Number	:

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/17/2015

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