Individual
AMY BROITMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1325 WESLEY AVE, EVANSTON, IL 60201-4117
(847) 475-4885
Mailing address
1325 WESLEY AVE, EVANSTON, IL 60201-4117
(847) 475-4885
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-003274
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149-003274
LCSW
IL
Enumeration date
03/13/2007
Last updated
05/01/2008
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