Active NPI
Mary Therese Boyle, LCSW
- Clinical Social Worker
- Wilmington, IL
National Provider Identifier
1104376375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.018807
- Practice address
- 523 Barnes Dr
Wilmington, IL 60481-1500 - Phone
- (773) 330-7102
- NPI assigned
- Oct 11, 2016
- Sex
- Female
- 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 | 149.018807 | IL | Primary |
Addresses
Primary practice location
523 Barnes Dr
Wilmington, IL 60481-1500
Mailing address
523 Barnes Dr
Wilmington, IL 60481-1500
Phone (773) 330-7102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 31, 2020 through Dec 31, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.018807 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476144000000",
"number": "1104376375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "523 BARNES DR",
"city": "WILMINGTON",
"state": "IL",
"postal_code": "604811500",
"telephone_number": "773-330-7102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "523 BARNES DR",
"city": "WILMINGTON",
"state": "IL",
"postal_code": "604811500",
"telephone_number": "773-330-7102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYLE",
"first_name": "MARY",
"middle_name": "THERESE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-11",
"last_updated": "2016-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.018807",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.