NPIMap

Organization Active NPI

Blue Moon Senior Counseling

  • Clinical Social Worker
  • Plainfield, IL
National Provider Identifier
1205129186
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW8327 Issued in FL
Legal business name
BLUE MOON SENIOR COUNSELING
Practice address
10204 Bode St Ste B
Plainfield, IL 60585-9813
Phone
(855) 241-7160
Fax
(954) 324-8354
NPI assigned
May 25, 2011
Last updated
May 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Authorized official

Name
Ms. Melanie Donohue, LCSWNPI 1477613750
Title
Owner
Phone
(702) 403-0438

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X SW8327 FL Primary

Addresses

Primary practice location

10204 Bode St Ste B
Plainfield, IL 60585-9813

Mailing address

10204 Bode St Ste B
Plainfield, IL 60585-9813
Phone (855) 241-7160

Other identifiers 1

IdentifierTypeStateIssuer
FL606AOtherFLMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111027000391 FL Part B Supplier - Clinic/Group Practice 6103099759 Receives reassigned benefits from 59 practitioners
Practice locations: Pompano Beach, FL; New Port Richey, FL; Palm Bay, FL; Lantana, FL; Palm Harbor, FL; Pinellas Park, FL; Wilton Manors, FL; Safety Harbor, FL…

National Provider Directory

National Provider Directory
Tax ID family
Blue Moon Senior Counseling2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

432 Sf St
Lake Worth, FL 33460
Phone (561) 383-2992

6400 Trouble Creek Rd
New Prt Rchy, FL 34653
Phone (727) 219-1732

2655 E Oakland Park Blvd
Ste 5
Oakland Park, FL 33306
Phone (954) 630-3131

3305 SE 5th St
Pompano Beach, FL 33062
Phone (954) 783-2317

3297 State Road 580
Safety Harbor, FL 34695
Phone (727) 724-3776

Practitioners & affiliated clinicians

Practitioners 74

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 74

NPI Registry JSON

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

{
    "created_epoch": "1306281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1205129186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10204 BODE ST STE B",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605859813",
            "telephone_number": "855-241-7160",
            "fax_number": "954-324-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10204 BODE ST STE B",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605859813",
            "telephone_number": "855-241-7160",
            "fax_number": "954-324-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE MOON SENIOR COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-25",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "DONOHUE",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-403-0438",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW8327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "FL606A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.