Carolyn Sue Endicott, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149-008683 Issued in IL

Practice address

2900 Frank Scott Pkwy W
Suite 956
Belleville, IL 62223-5000

Phone

(618) 233-3273

Fax

(618) 234-7233

NPI assigned

Apr 23, 2007

Last updated

Sep 23, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Carolyn Sue Plog Professional name

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

Specialty

Clinical Social Worker

Education

Washington University School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Live Well Counseling ServicesGroup PAC ID 5991002420, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Live Well Counseling Services

  • Clinical Social Worker
  • Venedy, IL
  • NPI 1881055838
  Medicare reassignment Care Compare group NPD
• The Ease Program

  • Community/Behavioral Health Agency
  • Belleville, IL
  • NPI 1316385990
  NPD (past)

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506124800000",
    "number": "1013135011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 FRANK SCOTT PKWY W",
            "address_2": "SUITE 956",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235000",
            "telephone_number": "618-233-3273",
            "fax_number": "618-234-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 FRANK SCOTT PKWY W",
            "address_2": "SUITE 956",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235000",
            "telephone_number": "618-233-3273",
            "fax_number": "618-234-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDICOTT",
        "first_name": "CAROLYN",
        "middle_name": "SUE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2017-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-008683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "PLOG",
            "middle_name": "SUE",
            "prefix": "MRS.",
            "credential": "MSW, LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kayla Emerick
• Cynthia Marie Emily, PA
• Empowerme Wellness Kansas City, LLC
• Empowerme Wellness Kansas City, LLC
• Nichelle Enata, MD
• Arthur T Engelage, D.M.D.
• Thomas E English, PHYSICAL THERAPIST
• James David Enyart, DC
• Epilepsy Foundation of Greater Southern Illinois
• Hailey Nicole Erdman

• Clinical Social Worker in Belleville, IL
• Providers in Belleville, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.