Laureen Michele Brotan, LCSW
Individual provider Active NPI Clinical Social Worker · Village of Lakewood, IL
NPI 1548086077 · NPPES record last updated Nov 30, 2024
Key facts
- NPI
- 1548086077
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 1490.15470 (IL)
- Practice address
- 8425 Owl CT
Village of Lakewood, IL 60014-3323 - Phone
- (847) 707-7220
- NPI assigned
- Nov 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Blue Moon Senior Counseling of Illinois LLC
Practice addresses (Care Compare)
10204 Bode St
Suite C
Plainfield, IL 60585-9813
Phone (630) 896-7160
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250218002259 | IL | Practitioner - Clinical Social Worker | 5496275679 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1490.15470 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Moon Senior Counseling of Illinois LLC | Clinical | Current |
Accepting new patients |
Locations
10204 Bode St
Ste B
Plainfield, IL 60585
Phone (630) 229-6462
10204 Bode St
Ste C
Plainfield, IL 60585
Phone (630) 844-7077
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1490.15470 | IL | Yes |
Addresses
Primary practice location
8425 Owl CT
Village of Lakewood, IL 60014-3323
Mailing address
8425 Owl CT
Village of Lakewood, IL 60014-3323
Phone (847) 707-7220
Other providers in Village of Lakewood, IL
All providers in Village of Lakewood, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.