Individual provider Active NPI

Fay L Myers, MDIV MSW LCSW

  • Clinical Social Worker
  • Homewood, IL
National Provider Identifier
1174627285
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
18154 Martin Ave
Suite 3
Homewood, IL 60430-2653
Phone
(708) 206-2755
Fax
(708) 957-9588
NPI assigned
Sep 11, 2006
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

18154 Martin Ave
Suite 3
Homewood, IL 60430-2653

Mailing address

18154 Martin Ave
Suite 3
Homewood, IL 60430-2653
Phone (708) 206-2755

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
149003916ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174627285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18154 MARTIN AVE",
            "address_2": "SUITE 3",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302653",
            "telephone_number": "708-206-2755",
            "fax_number": "708-957-9588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18154 MARTIN AVE",
            "address_2": "SUITE 3",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302653",
            "telephone_number": "708-206-2755",
            "fax_number": "708-957-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "FAY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MDIV MSW LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homewood, 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.