Individual provider Active NPI

Janice Benedict, LCSW

  • Clinical Social Worker
  • Rockford, IL
National Provider Identifier
1174896765
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149017083 Issued in IL
Practice address
6975 Redansa Dr
Rockford, IL 61108-1201
Phone
(815) 398-7000
NPI assigned
Feb 14, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2021

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 149017083 IL Primary

Addresses

Primary practice location

6975 Redansa Dr
Rockford, IL 61108-1201

Mailing address

3710 Corbridge LN
Rockford, IL 61107-3548
Phone (815) 986-1113

Other identifiers 1

IdentifierTypeStateIssuer
149017083OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Clinic of Psychiatric Care Past Accepting new patients
Progressive Chiropractic Wellness & Rehab Centre, P.C. PastSince Jul 2, 2016 Accepting new patients

Organizations & group practices 2

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": "1329177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1174896765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3710 CORBRIDGE LN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073548",
            "telephone_number": "815-986-1113",
            "fax_number": "815-986-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6975 REDANSA DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611081201",
            "telephone_number": "815-398-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENEDICT",
        "first_name": "JANICE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-14",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149017083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "149017083",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.