Mary Susan Fidale, LCPC, RNC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.003182 Issued in IL

Practice address

4160 RT 83 Suite 206
Long Grove, IL 60047-9585

Phone

(847) 217-6190

NPI assigned

Jun 7, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1023467420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 681281",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601681281",
            "telephone_number": "847-217-6190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 RT 83 SUITE 206",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600479585",
            "telephone_number": "847-217-6190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIDALE",
        "first_name": "MARY SUSAN",
        "name_prefix": "Ms.",
        "credential": "LCPC, RNC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-07",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.003182",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.211850",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Long Grove, IL
• Providers in Long Grove, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; 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.