Individual provider Active NPI

Larisa Joyce McEachran Leader, LCSW

  • Clinical Social Worker
  • McHenry, IL
National Provider Identifier
1174922470
Registry record updated Jan 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.016961 Issued in IL
Practice address
1907 Pine Dr
McHenry, IL 60051-2600
Phone
(734) 740-8877
NPI assigned
Aug 22, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2017

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 149.016961 IL Primary

Addresses

Primary practice location

1907 Pine Dr
McHenry, IL 60051-2600

Mailing address

1907 Pine Dr
McHenry, IL 60051-2600
Phone (734) 740-8877

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
149.016961ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485388800000",
    "number": "1174922470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 PINE DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600512600",
            "telephone_number": "734-740-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 PINE DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600512600",
            "telephone_number": "734-740-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEADER",
        "first_name": "LARISA",
        "middle_name": "JOYCE MCEACHRAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-22",
        "last_updated": "2017-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.016961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; 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.