Individual provider Active NPI

Robert J McNicholl, MSW, LCSW

  • Clinical Social Worker
  • Champaign, IL
National Provider Identifier
1093948440
Registry record updated Jan 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.013155 Issued in IL
Practice address
201 W Springfield Ave Ste 1201
Champaign, IL 61820-6385
Phone
(217) 722-9079
Fax
(217) 501-4322
NPI assigned
Sep 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 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 Worker 1041C0700X 149.013155 IL Primary

Addresses

Primary practice location

201 W Springfield Ave Ste 1201
Champaign, IL 61820-6385

Mailing address

201 W Springfield Ave Ste 1201
Champaign, IL 61820-6385
Phone (217) 722-9079

Other practice location 1

1612 Patton Dr
Mahomet, IL 61853-8157
Phone (217) 590-4178

Other names 1

  • R.J. McNicholl Other name

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

LicenseStateTypeSpecialty
149.013155ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
McNicholl Counseling, P.C. Clinical CurrentSince Jan 19, 2025 Accepting new patients

Locations

1612 Patton Dr
Mahomet, IL 61853
Phone (217) 590-4178

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1251849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737158400000",
    "number": "1093948440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W SPRINGFIELD AVE STE 1201",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618206385",
            "telephone_number": "217-722-9079",
            "fax_number": "217-501-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W SPRINGFIELD AVE STE 1201",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618206385",
            "telephone_number": "217-722-9079",
            "fax_number": "217-501-4322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1612 Patton Dr",
            "address_purpose": "LOCATION",
            "city": "Mahomet",
            "state": "IL",
            "postal_code": "618538157",
            "country_code": "US",
            "telephone_number": "217-590-4178",
            "fax_number": "217-501-4322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCNICHOLL",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-02",
        "last_updated": "2025-01-18",
        "certification_date": "2025-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.013155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "R.J.",
            "last_name": "MCNICHOLL",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.