Active NPI
Eugene Carroll Marceron Jr., LCSW
- Clinical Social Worker
- Waukegan, IL
National Provider Identifier
1093007064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149009694
- Practice address
- 2025 Washington St
Waukegan, IL 60085-5131 - Phone
- (847) 360-1020
- Fax
- (847) 360-1065
- NPI assigned
- May 10, 2011
- 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 | 149009694 | IL | Primary |
Addresses
Primary practice location
2025 Washington St
Waukegan, IL 60085-5131
Mailing address
2025 Washington St
Waukegan, IL 60085-5131
Phone (847) 360-1020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304985600000",
"number": "1093007064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2025 WASHINGTON ST",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600855131",
"telephone_number": "847-360-1020",
"fax_number": "847-360-1065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 WASHINGTON ST",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600855131",
"telephone_number": "847-360-1020",
"fax_number": "847-360-1065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCERON",
"first_name": "EUGENE",
"middle_name": "CARROLL",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-10",
"last_updated": "2011-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149009694",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.