Active NPI
Beth Bollenbach, LCSW
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1396825592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149-006193
- Practice address
- 1731 N Marcey St
Suite 511
Chicago, IL 60614-5373 - Phone
- (773) 497-2604
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149-006193 | IL | Primary |
Addresses
Primary practice location
1731 N Marcey St
Suite 511
Chicago, IL 60614-5373
Mailing address
1731 N Marcey St
Suite 511
Chicago, IL 60614-5373
Phone (773) 497-2604
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040414000019 | IL | Practitioner - Clinical Social Worker | 3971597766 | Practice locations: Chicago, IL |
| I20240910000143 | MI | Practitioner - Clinical Social Worker | 3971597766 | Practice locations: Three Oaks, MI |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
14671 Three Oaks Rd
Three Oaks, MI 49128-9714
Phone (773) 497-2604
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149-006193 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484265600000",
"number": "1396825592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1731 N MARCEY ST",
"address_2": "SUITE 511",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606145373",
"telephone_number": "773-497-2604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1731 N MARCEY ST",
"address_2": "SUITE 511",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606145373",
"telephone_number": "773-497-2604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLLENBACH",
"first_name": "BETH",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2017-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149-006193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; 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.