Individual provider Active NPI

Jane Rosenblum, LCSW

  • Clinical Social Worker
  • Deerfield, IL
National Provider Identifier
1508624479
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149-007576 Issued in IL
Practice address
1336 Oxford Rd
Deerfield, IL 60015-2316
Phone
(847) 987-0996
NPI assigned
Mar 6, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 112269 TX
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 149-007576 IL Primary

Addresses

Primary practice location

1336 Oxford Rd
Deerfield, IL 60015-2316

Mailing address

1336 Oxford Rd
Deerfield, IL 60015-2316
Phone (847) 987-0996

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240802003752 IL Practitioner - Clinical Social Worker 7517401219

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149-007576ILMDClinical Social Worker
112269TXMDPharmacy Technician

NPI Registry JSON

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

{
    "created_epoch": "1709683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1508624479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1336 OXFORD RD",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600152316",
            "telephone_number": "847-987-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 OXFORD RD",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600152316",
            "telephone_number": "847-987-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBLUM",
        "first_name": "JANE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-06",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "112269",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-007576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deerfield, IL

Sources for this page

Verify at the official NPI Registry.