Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Blake A Bullock, LCSW

Individual provider Clinical Social Worker · NPI 1295505014

Blake A Bullock, LCSW is a Clinical Social Worker in Evanston, Illinois. Qualified in 2017, 9 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in Illinois.

Years since qualifying
9
Licensed in
IL
In the registry since
2024
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

708 Church St Ste 223
Evanston, IL 60201-3881
Phone: (312) 620-0396
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1649 W Pratt Blvd Apt 3b, Chicago, IL 60626-4127 — (309) 540-8401

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 149.024395 (IL)

Record details

NPI number1295505014
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedJanuary 3, 2024
Last updated in NPPESJuly 2, 2025
Certification dateJuly 2, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Not indicated

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