Individual provider Active NPI

Richard Ward Cornwall, LCSW

  • Clinical Social Worker
  • Barrington, IL
National Provider Identifier
1194218909
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149027305 Issued in IL
Practice address
118 Applebee St
Barrington, IL 60010-3035
Phone
(847) 381-0345
Fax
(630) 859-2994
NPI assigned
Jun 7, 2018
Last updated
Jun 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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 149027305 IL Primary

Addresses

Primary practice location

118 Applebee St
Barrington, IL 60010-3035

Mailing address

118 Applebee St
Barrington, IL 60010-3035
Phone (847) 381-0345

Other identifiers 1

IdentifierTypeStateIssuer
1821151119MedicaidIL

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
149027305ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Barrington Youth and Family Services Social Worker CurrentSince Jun 16, 2024 Accepting new patients
Cornwall Counseling Clinic PLLC Clinical Current Accepting new patients

Locations

118 Applebee St
Barrington, IL 60010
Phone (847) 381-0345

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, 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": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1194218909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 APPLEBEE ST",
            "city": "BARRINGTON",
            "state": "IL",
            "postal_code": "600103035",
            "telephone_number": "847-381-0345",
            "fax_number": "630-859-2994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 APPLEBEE ST",
            "city": "BARRINGTON",
            "state": "IL",
            "postal_code": "600103035",
            "telephone_number": "847-381-0345",
            "fax_number": "630-859-2994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNWALL",
        "first_name": "RICHARD",
        "middle_name": "WARD",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-07",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149027305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821151119",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Barrington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.