Tara Alisabeth Bagnola

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149026008 Issued in IL

Practice address

361 Park Ave
Glencoe, IL 60022-1587

Phone

(773) 828-0127

NPI assigned

Apr 11, 2022

Last updated

Oct 19, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Service of Glencoe

  • Counselor
  • Glencoe, IL
  • NPI 1518044890
  NPD

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1104568021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 N HAMLIN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471007",
            "telephone_number": "773-983-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 PARK AVE",
            "city": "GLENCOE",
            "state": "IL",
            "postal_code": "600221587",
            "telephone_number": "773-828-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGNOLA",
        "first_name": "TARA",
        "middle_name": "ALISABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-11",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149026008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shona Angle, MSW LCSW
• Victoria Aron
• Associates in Adolescent Psychiatry SC
• Julie Bendix, RD
• Kimberly Berka
• Ellen R Blumenthal, LCSW
• Michael P Bobrow, DDS
• Darrell David Brayboy, L.AC.

• Clinical Social Worker in Glencoe, IL
• Providers in Glencoe, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.