Active NPI
Jacqueline Estelle Bellefontaine, LCSW
- Social Worker
- Chicago, IL
National Provider Identifier
1124896717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 149026409
- Practice address
- 1451 N Maplewood Ave Apt 1R
Chicago, IL 60622-1880 - Phone
- (630) 456-6718
- NPI assigned
- Dec 13, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 149026409 | IL | Primary |
Addresses
Primary practice location
1451 N Maplewood Ave Apt 1R
Chicago, IL 60622-1880
Mailing address
1451 N Maplewood Ave Apt 1R
Chicago, IL 60622-1880
Phone (630) 456-6718
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149026409 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wildflower Center for Emotional Health PLLC | 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.
-
- Clinical Social Worker
- Chicago, IL
- NPI 1114342599
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706659200000",
"number": "1124896717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1451 N MAPLEWOOD AVE APT 1R",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606221880",
"telephone_number": "630-456-6718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1451 N MAPLEWOOD AVE APT 1R",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606221880",
"telephone_number": "630-456-6718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BELLEFONTAINE",
"first_name": "JACQUELINE",
"middle_name": "ESTELLE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-13",
"last_updated": "2024-01-31",
"certification_date": "2024-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "149026409",
"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 Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.