Active NPI
Autumn E Starks, LCSW
- Clinical Social Worker
- Oak Park, IL
National Provider Identifier
1063700029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.014692
- Practice address
- 1122 Westgate St
Suite 204a
Oak Park, IL 60301-1170 - Phone
- (810) 516-4991
- NPI assigned
- Jul 12, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.014692 | IL | Primary |
Addresses
Primary practice location
1122 Westgate St
Suite 204a
Oak Park, IL 60301-1170
Mailing address
1122 Westgate St
Suite 204a
Oak Park, IL 60301-1170
Phone (810) 516-4991
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1616824 | Other | IL | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.014692 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320192000000",
"number": "1063700029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1122 WESTGATE ST",
"address_2": "SUITE 204A",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011170",
"telephone_number": "810-516-4991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1122 WESTGATE ST",
"address_2": "SUITE 204A",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011170",
"telephone_number": "810-516-4991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARKS",
"first_name": "AUTUMN",
"middle_name": "E",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-12",
"last_updated": "2011-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.014692",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1616824",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.