Active NPI
Stephanie L. Loda, LCSW
- Clinical Social Worker
- Arlington Heights, IL
National Provider Identifier
1104817600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149-010982
- Practice address
- 2 S Patton Ave
Arlington Heights, IL 60005-1654 - Phone
- (847) 830-9512
- Fax
- (847) 368-0847
- NPI assigned
- Nov 2, 2005
- 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 | 149-010982 | IL | Primary |
Addresses
Primary practice location
2 S Patton Ave
Arlington Heights, IL 60005-1654
Mailing address
2 S Patton Ave
Arlington Heights, IL 60005-1654
Phone (847) 830-9512
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 780778000 | Other | IL | MAGELLAN |
| 0001634867 | Other | IL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 27, 2023 through Jun 27, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149-010982 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jennifer E. Manfre, LTD | Clinical | Past | Accepting new patients |
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": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723420800000",
"number": "1104817600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 S PATTON AVE",
"city": "ARLINGTON HEIGHTS",
"state": "IL",
"postal_code": "600051654",
"telephone_number": "847-830-9512",
"fax_number": "847-368-0847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 S PATTON AVE",
"city": "ARLINGTON HEIGHTS",
"state": "IL",
"postal_code": "600051654",
"telephone_number": "847-830-9512",
"fax_number": "847-368-0847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LODA",
"first_name": "STEPHANIE",
"middle_name": "L.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-02",
"last_updated": "2024-08-12",
"certification_date": "2024-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149-010982",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "780778000",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0001634867",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Arlington Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.