Individual provider Active NPI

Brenda J Nemeth, LCSW

  • Clinical Social Worker
  • Crystal Lake, IL
National Provider Identifier
1164504379
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
14 Brink St
Crystal Lake, IL 60014-4302
Phone
(815) 455-6736
Fax
(815) 455-9744
NPI assigned
Oct 19, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X IL Primary

Addresses

Primary practice location

14 Brink St
Crystal Lake, IL 60014-4302

Mailing address

14 Brink St
Crystal Lake, IL 60014-4302
Phone (815) 455-6736

Other identifiers 1

IdentifierTypeStateIssuer
0005615149OtherILBCBS

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
149003534ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Illinois Counseling Associates, P.C. 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164504379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 BRINK ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600144302",
            "telephone_number": "815-455-6736",
            "fax_number": "815-455-9744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 BRINK ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600144302",
            "telephone_number": "815-455-6736",
            "fax_number": "815-455-9744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEMETH",
        "first_name": "BRENDA",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0005615149",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.