Fitzgerald Ajoku
Individual provider Active NPI Clinical Social Worker · Lake Bluff, IL
NPI 1104583418 · NPPES record last updated Feb 3, 2025
Key facts
- NPI
- 1104583418
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 128146 (CA)
- Practice address
- 30047 N Waukegan Rd
Lake Bluff, IL 60044-1023 - Phone
- (914) 609-1183
- NPI assigned
- Nov 22, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231207003482 | IL | Practitioner - Clinical Social Worker | 0244689982 | Reassigns benefits to 1 organization |
| I20240126000597 | TX | Practitioner - Clinical Social Worker | 0244689982 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128146 | CA | MD | Marriage & Family Therapist |
| 109816 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Black Excellence Psychotherapy PLLC | Current |
Accepting new patients | |
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
| Brightside Medical, P.a. | Current |
Accepting new patients | |
| Millennium Mental Health Concepts LLC | Clinical | Current | Accepting new patients |
Locations
2261 Market St
San Francisco, CA 94114
Phone (213) 337-4615
1440 W Taylor St
Chicago, IL 60607
Phone (612) 263-9334
Interoperability endpoints
- fitzgeraldajoku@tdh.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 128146 | CA | Yes |
| Clinical Social Worker | 1041C0700X |
Addresses
Primary practice location
30047 N Waukegan Rd
Lake Bluff, IL 60044-1023
Mailing address
30047 N Waukegan Rd
Lake Bluff, IL 60044-1023
Other providers in Lake Bluff, IL
- Accelerated Rehabilitation Centers, LTD
- Advanced Interventional Pain Solutions LTD
- Advantage Home Health Plus, Inc.
- Sonia Allegretti
- Allied Counseling Services PC
- Charles Alvarado
- Amy Carnow, PC
- Morgan Anzelone
All providers in Lake Bluff, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.