MEDICARE: EMILY JONES SIMON ROSENBLOOM 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	149.021569	IL

General Provider Information

NPI Number	:	1982240255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JONES SIMON ROSENBLOOM LCSW

Provider Business Mailing Address
First Line	:	3436 N BELL AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6002
Country	:	US
Telephone Number	:	520-338-6407
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 N BELL AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6002
Country	:	US
Telephone Number	:	773-717-2502
Fax Number	:

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

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	02/18/2022

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