NPIMap

Organization Active NPI

Edgewood Clinical Services of Plainfield

  • Mental Health Counselor
  • Plainfield, IL
National Provider Identifier
1043464803
Registry record updated Nov 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
149010253 Issued in IL
Legal business name
EDGEWOOD CLINICAL SERVICES OF PLAINFIELD
Practice address
14722 S Naperville Rd
Suite 112
Plainfield, IL 60544-3302
Phone
(630) 428-7890
NPI assigned
Nov 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2008

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

Authorized official

Name
Adam Russo, LCSW
Title
Executive Director
Phone
(630) 428-7890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 149010253 IL Primary

Addresses

Primary practice location

14722 S Naperville Rd
Suite 112
Plainfield, IL 60544-3302

Mailing address

PO Box 5222
Naperville, IL 60567-5222
Phone (630) 428-7890

National Provider Directory

National Provider Directory

Locations

14722 S Naperville Rd
Ste 112
Plainfield, IL 60544

Practitioners & affiliated clinicians

Practitioners 2

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": "1225929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225929600000",
    "number": "1043464803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5222",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605675222",
            "telephone_number": "630-428-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14722 S NAPERVILLE RD",
            "address_2": "SUITE 112",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605443302",
            "telephone_number": "630-428-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD CLINICAL SERVICES OF PLAINFIELD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-06",
        "last_updated": "2008-11-06",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-428-7890",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "149010253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2008; 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.