NPIMap

Organization Active NPI

Clinically Queer, LLC

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1124761044
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CLINICALLY QUEER, LLC
Practice address
5639 N Wayne Ave
Chicago, IL 60660-4472
Phone
(240) 660-6018
NPI assigned
Apr 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Authorized official

Name
Chelsea Fry, LCSW-CNPI 1558836296
Title
Owner
Phone
(240) 660-6018

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

5639 N Wayne Ave
Chicago, IL 60660-4472

Mailing address

5639 N Wayne Ave
Chicago, IL 60660-4472
Phone (240) 660-6018

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1650240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1124761044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5639 N WAYNE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606604472",
            "telephone_number": "240-660-6018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5639 N WAYNE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606604472",
            "telephone_number": "240-660-6018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICALLY QUEER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-18",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "FRY",
        "authorized_official_first_name": "CHELSEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-660-6018",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.