Angela R Black Childers, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149007668 Issued in IL

Practice address

600 Spring Hill Ring Rd
Suite 113 a
West Dundee, IL 60118-7300

Phone

(815) 600-1999

NPI assigned

Sep 18, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1023368941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 WARNER ST",
            "city": "HAMPSHIRE",
            "state": "IL",
            "postal_code": "601409461",
            "telephone_number": "815-600-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SPRING HILL RING RD",
            "address_2": "SUITE 113 A",
            "city": "WEST DUNDEE",
            "state": "IL",
            "postal_code": "601187300",
            "telephone_number": "815-600-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK CHILDERS",
        "first_name": "ANGELA",
        "middle_name": "R",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-18",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149007668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Graziella I Bistriceanu, M.D.
• Bodyworks Medical Center of WD PLLC
• Bodyworks Medical Center of West Dundee PLLC
• Erin Bracken, LCSW
• John J Buckley, LCPC
• Nicole Rae Butcher, OTR/L

• Clinical Social Worker in West Dundee, IL
• Providers in West Dundee, 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 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.