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NPI Code Detail

MEDICARE: MR. BENJAMIN SEVERANCE LCSW

MEDICARE: MR. BENJAMIN SEVERANCE 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
11041C0700XClinical Social Worker149020763IL
2101Y00000XCounselor

General Provider Information

NPI Number : 1902178379
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENJAMIN SEVERANCE LCSW
Provider Business Mailing Address
First Line : 1203 W AUGUSTA BLVD STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60642-4327
Country : US
Telephone Number : 773-248-2255
Fax Number :
Provider Business Practice Location Address
First Line : 1203 W AUGUSTA BLVD STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60642-4327
Country : US
Telephone Number : 773-248-2255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2012
Last Update Date : 03/03/2025

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