Individual provider Active NPI

Elizabeth Casaclang-Melo, MA, LPC, CADC

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1205348703
Registry record updated Nov 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
178.002996 Issued in IL
Practice address
3976 N Avondale Ave
Chicago, IL 60641-2900
Phone
(847) 462-6099
Fax
(847) 628-6064
NPI assigned
Oct 25, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 30088 IL
Professional Counselor 101YP2500X 178.002996 IL Primary

Addresses

Primary practice location

3976 N Avondale Ave
Chicago, IL 60641-2900

Mailing address

3976 N Avondale Ave FL 2
Chicago, IL 60641-2900
Phone (630) 428-7890

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
30088ILMDAddiction (Substance Use Disorder) Counselor
178.002996ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. CurrentSince Nov 12, 2023 Accepting new patients

Locations

3976 N Avondale Ave
Fl 2
Chicago, IL 60641
Phone (312) 319-4162

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1508889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1205348703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3976 N AVONDALE AVE FL 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412900",
            "telephone_number": "630-428-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3976 N AVONDALE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412900",
            "telephone_number": "847-462-6099",
            "fax_number": "847-628-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASACLANG-MELO",
        "first_name": "ELIZABETH",
        "credential": "MA, LPC, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-25",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "30088",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.002996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.