Individual provider Active NPI

Diane Marie Gorman I, LCSW

  • Clinical Social Worker
  • Waukegan, IL
National Provider Identifier
1093985848
Registry record updated Mar 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
2504 Washington St
Waukegan, IL 60085-4983
Phone
(847) 692-6495
NPI assigned
Mar 7, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2008

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 IL Primary

Addresses

Primary practice location

2504 Washington St
Waukegan, IL 60085-4983

Mailing address

57 Summit Ave
Park Ridge, IL 60068-4103
Phone (847) 692-6495

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041217000238 IL Practitioner - Clinical Social Worker 1355308669 Reassigns benefits to 1 organization
Practice locations: Waukegan, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Josselyn Center NFPGroup PAC ID 0840289740, 86 clinicians

Practice addresses (Care Compare)

415 Washington St
Waukegan, IL 60085-5564
Phone 8474415600136

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Josselyn Center NFP Current Accepting new patients
The Josselyn Center NFP CurrentSince Sep 11, 2023 Accepting new patients
The Josselyn Center CurrentSince Sep 11, 2023 Accepting new patients
Arden Shore Child & Family Services Clinical Past Accepting new patients
Arden Shore Child and Family Services Past Accepting new patients
The Josselyn Center NFP Past Accepting new patients

Locations

1135 Skokie Blvd
Northbrook, IL 60062
Phone (773) 430-3351

405 Central Ave
Northfield, IL 60093
Phone (847) 441-5603

415 Washington St
Waukegan, IL 60085
Phone (224) 480-4494

Organizations & group practices 6

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": "1204848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204848000000",
    "number": "1093985848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 SUMMIT AVE",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684103",
            "telephone_number": "847-692-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 WASHINGTON ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600854983",
            "telephone_number": "847-692-6495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMAN",
        "first_name": "DIANE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "name_suffix": "I",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-07",
        "last_updated": "2008-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

Verify at the official NPI Registry.