Ivelisse Burgo, PSYD, LPC, NCC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071.010821 Issued in IL

Practice address

828 Davis St Ste 213
Evanston, IL 60201-4420

Phone

(312) 781-2850

Fax

(847) 972-6445

NPI assigned

Aug 23, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Ivy Burgo Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Burgo & Associates, PLLC

  • Psychologist
  • Park Ridge, IL
  • NPI 1275244717
  NPD
• Chicago Psych Therapy Group, Inc.

  • Clinical Psychologist
  • Evanston, IL
  • NPI 1184165383
  NPD

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

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1083169791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 DAVIS ST STE 213",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014420",
            "telephone_number": "312-781-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 DAVIS ST STE 213",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014420",
            "telephone_number": "312-781-2850",
            "fax_number": "847-972-6445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGO",
        "first_name": "IVELISSE",
        "name_prefix": "Dr.",
        "credential": "PSYD, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-23",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.013118",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071.010821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVY",
            "last_name": "BURGO",
            "prefix": "DR.",
            "credential": "PSYD, LPC, NCC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Briyanna Bullock, M.ED, LPC
• Zachary B. Bulwa, MD, MS
• Rebecca Bunn
• Elizabeth Buonauro
• Karen L. Burey, P.T.
• Nereza Mia Burgos, APN-CRNA
• Susan Burkhardt, LCSW
• Ana Maria Burlea, DO
• Luke Patrick Burns, MD
• Martha S. Burns, PH.D.

• Psychologist in Evanston, IL
• Providers in Evanston, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.