Active NPI
Derrick Dunmore
- Clinical Social Worker
- Bolingbrook, IL
National Provider Identifier
1073335675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149026406
- Practice address
- 246 Clubhouse St
Bolingbrook, IL 60490-2059 - Phone
- (630) 742-6899
- NPI assigned
- Oct 26, 2024
- Sex
- Male
- 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 | 149026406 | IL | Primary |
Addresses
Primary practice location
246 Clubhouse St
Bolingbrook, IL 60490-2059
Mailing address
246 Clubhouse St
Bolingbrook, IL 60490-2059
Phone (630) 742-6899
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
| License | State | Type | Specialty |
|---|---|---|---|
| 149026406 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729900800000",
"number": "1073335675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "246 CLUBHOUSE ST",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604902059",
"telephone_number": "630-742-6899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "246 CLUBHOUSE ST",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604902059",
"telephone_number": "630-742-6899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUNMORE",
"first_name": "DERRICK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-10-26",
"last_updated": "2024-10-26",
"certification_date": "2024-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149026406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.