NPIMap

Organization Active NPI

Self Design, Inc

  • Clinical Social Worker
  • Evanston, IL
National Provider Identifier
1023374261
Registry record updated Apr 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.006816 Issued in IL
Legal business name
SELF DESIGN, INC
Practice address
1007 Church St
Suite 515
Evanston, IL 60201-3624
Phone
(773) 818-6800
NPI assigned
Apr 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2012

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

Authorized official

Name
Julie Blackman, LCSWNPI 1578694691
Title
President/Owner
Phone
(773) 818-6800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 149.006816 IL Primary

Addresses

Primary practice location

1007 Church St
Suite 515
Evanston, IL 60201-3624

Mailing address

1007 Church St
Suite 515
Evanston, IL 60201-3624
Phone (773) 818-6800

Other names 1

  • Julie LCSW, Ltd Former legal business name

National Provider Directory

National Provider Directory

Locations

1007 Church St
Ste 515
Evanston, IL 60201
Phone (312) 307-9677

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333324800000",
    "number": "1023374261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 CHURCH ST",
            "address_2": "SUITE 515",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013624",
            "telephone_number": "773-818-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 CHURCH ST",
            "address_2": "SUITE 515",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013624",
            "telephone_number": "773-818-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF DESIGN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-02",
        "last_updated": "2012-04-02",
        "status": "A",
        "authorized_official_last_name": "BLACKMAN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "773-818-6800",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.006816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Julie LCSW, Ltd",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.