NPIMap

Organization Active NPI

Neuroclinic and Assessments, LLC

  • Clinical Psychologist
  • McHenry, IL
National Provider Identifier
1053673988
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071008295 Issued in IL
Legal business name
NEUROCLINIC AND ASSESSMENTS, LLC
Practice address
659 Ridgeview Dr
McHenry, IL 60050-7012
Phone
(815) 344-1999
Fax
(815) 516-5171
NPI assigned
Jun 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Dr. Joshua C. Lavigne, PH.DNPI 1174896633
Title
Director
Phone
(815) 344-1999

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103G00000X 071008295 IL
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X 071008295 IL Primary

Addresses

Primary practice location

659 Ridgeview Dr
McHenry, IL 60050-7012

Mailing address

659 Ridgeview Dr
McHenry, IL 60050-7012
Phone (815) 344-1999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130103000288 IL Part B Supplier - Clinic/Group Practice 1658524475 Receives reassigned benefits from 6 practitioners
Practice locations: McHenry, IL; Schaumburg, IL

National Provider Directory

National Provider Directory

Locations

659 Ridgeview Dr
McHenry, IL 60050
Phone (312) 961-9974

Practitioners & affiliated clinicians

Practitioners 9

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": "1339718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1053673988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "659 RIDGEVIEW DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507012",
            "telephone_number": "815-344-1999",
            "fax_number": "815-516-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "659 RIDGEVIEW DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507012",
            "telephone_number": "815-344-1999",
            "fax_number": "815-516-5171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROCLINIC AND ASSESSMENTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-15",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "LAVIGNE",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "815-344-1999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071008295",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.