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

Individual provider Social Worker · NPI 1679793913

Mr. Jerome Pietrusiak, LICENSEDCLINICALSO is a Clinical Social Worker in Chicago, Illinois. Qualified in 1983, 43 years ago. Practices with Pcc Community Wellness Center, a 89-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
43
Licensed in
IL
In the registry since
2007
Specialties on file
2
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Practice location Address checks out

3456 W Franklin Blvd
Chicago, IL 60624-1308
Phone: (773) 533-6013
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 149.002241 (IL)
Social Worker Taxonomy 104100000X · Licence 149002241 (IL)

Record details

NPI number1679793913
Entity typeIndividual (Type 1)
GenderMale
Credentials LICENSEDCLINICALSO
Sole proprietorNo
NPI enumeratedApril 27, 2007
Last updated in NPPESDecember 26, 2019
Certification dateDecember 26, 2019

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1983 (43 years in practice)
Group practice Pcc Community Wellness Center — 89 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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