NPIMap

Organization Active NPI

Provena St Marys Hospital

  • Clinical Social Worker
  • Bourbonnais, IL
National Provider Identifier
1194982025
Registry record updated May 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149006455 Issued in IL
Legal business name
PROVENA ST MARYS HOSPITAL
Practice address
21 Heritage Drive
Suite 102
Bourbonnais, IL 60914
Phone
(815) 937-2081
Fax
(815) 937-8798
NPI assigned
May 19, 2008
Last updated
May 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2008

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

Authorized official

Name
Mr. Barry S Lee, LCSW CADC
Title
Eap Substance Abuse Counselor
Phone
(815) 937-2081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149006455 IL Primary

Addresses

Primary practice location

21 Heritage Drive
Suite 102
Bourbonnais, IL 60914

Mailing address

21 Heritage Drive
Suite 102
Bourbonnais, IL 60914
Phone (815) 937-2081

National Provider Directory

National Provider Directory
Tax ID family
Provena Covenant Med CT16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1194982025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 HERITAGE DRIVE",
            "address_2": "SUITE 102",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-937-2081",
            "fax_number": "815-937-8798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 HERITAGE DRIVE",
            "address_2": "SUITE 102",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-937-2081",
            "fax_number": "815-937-8798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENA ST MARYS HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EAP SUBSTANCE ABUSE COUNSELOR",
        "authorized_official_telephone_number": "815-937-2081",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW CADC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149006455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.