Blake A Bullock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.024395 Issued in IL

Practice address

708 Church St Ste 223
Evanston, IL 60201-3881

Phone

(312) 620-0396

NPI assigned

Jan 3, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Health Centers of the Rutland Region Inc

  • Federally Qualified Health Center (FQHC)
  • Rutland, VT
  • NPI 1467681114
  NPD
• Community Health Centers of the Rutland Region Inc

  • Federally Qualified Health Center (FQHC)
  • Rutland, VT
  • NPI 1518613215
  NPD
• Community Health Centers of the Rutland Region, Inc.

  • Family Medicine Physician
  • Brandon, VT
  • NPI 1073567590
  NPD
• Community Health Centers of the Rutland Region, Inc.

  • Family Medicine Physician
  • West Pawlet, VT
  • NPI 1104870922
  NPD
• Community Health Centers of the Rutland Region, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bomoseen, VT
  • NPI 1336193838
  NPD
• Community Health Centers of the Rutland Region, Inc.

  • Pediatrics Physician
  • Rutland, VT
  • NPI 1780969345
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1295505014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1649 W PRATT BLVD APT 3B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264127",
            "telephone_number": "309-540-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 CHURCH ST STE 223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013881",
            "telephone_number": "312-620-0396"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1649 W Pratt Blvd Apt 3B",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606264127",
            "country_code": "US",
            "telephone_number": "309-540-8401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "BLAKE",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-03",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.024395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aliya Budman
• Livia Adia Budrys, LCSW
• Anh Que Bui, M.D.
• Fatima Z Bukhari, O.D.
• Lauren Kathleen Bulgarelli
• Briyanna Bullock, M.ED, LPC
• Zachary B. Bulwa, MD, MS
• Rebecca Bunn
• Elizabeth Buonauro
• Karen L. Burey, P.T.

• Clinical Social Worker in Evanston, IL
• Providers in Evanston, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.