NPIMap

Organization Active NPI

Light on Anxiety

  • Social Worker
  • Wilmette, IL
National Provider Identifier
1184267478
Registry record updated Oct 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
LIGHT ON ANXIETY
Practice address
3330 Old Glenview Rd Ste 14
Wilmette, IL 60091-2963
Phone
(312) 508-3645
NPI assigned
Oct 19, 2019
Last updated
Oct 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2019

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

Authorized official

Name
Dr. Debra Kissen, PHD
Title
Ceo
Phone
(312) 508-3645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X Primary

Addresses

Primary practice location

3330 Old Glenview Rd Ste 14
Wilmette, IL 60091-2963

Mailing address

100 Saunders Rd Ste 150
Lake Forest, IL 60045-2526

Other practice location 1

844 Peter Ct
Indian Creek, IL 60061-3267
Phone (224) 688-6327

Other identifiers 1

IdentifierTypeStateIssuer
150.104002OtherILLICENSED SOCIAL WORKER

National Provider Directory

National Provider Directory

Locations

3330 Old Glenview Rd
Ste 14
Wilmette, IL 60091
Phone (847) 610-6763

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1571443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571443200000",
    "number": "1184267478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SAUNDERS RD STE 150",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 OLD GLENVIEW RD STE 14",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912963",
            "telephone_number": "312-508-3645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "844 Peter Ct",
            "address_purpose": "LOCATION",
            "city": "Indian Creek",
            "state": "IL",
            "postal_code": "600613267",
            "country_code": "US",
            "telephone_number": "224-688-6327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIGHT ON ANXIETY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-19",
        "last_updated": "2019-10-19",
        "status": "A",
        "authorized_official_last_name": "KISSEN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-508-3645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED SOCIAL WORKER",
            "identifier": "150.104002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmette, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2019; 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.