Individual provider Active NPI

Douglas Raymond Depalma

  • Clinical Social Worker
  • Libertyville, IL
National Provider Identifier
1063376390
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
150118558 Issued in IL
Practice address
900 Technology Way Ste 320
Libertyville, IL 60048-5364
Phone
(847) 680-2715
Fax
(847) 680-3832
NPI assigned
Dec 11, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 150118558 IL Primary

Addresses

Primary practice location

900 Technology Way Ste 320
Libertyville, IL 60048-5364

Mailing address

900 Technology Way Ste 320
Libertyville, IL 60048-5364
Phone (847) 680-2715

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
150118558ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1765411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1063376390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 TECHNOLOGY WAY STE 320",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485364",
            "telephone_number": "847-680-2715",
            "fax_number": "847-680-3832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 TECHNOLOGY WAY STE 320",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485364",
            "telephone_number": "847-680-2715",
            "fax_number": "847-680-3832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPALMA",
        "first_name": "DOUGLAS",
        "middle_name": "RAYMOND",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-12-11",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "150118558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; 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.