Constance Anita Fullilove, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-002239 Issued in IL

Practice address

205 W Randolph St Ste 830
Chicago, IL 60606-1815

Phone

(312) 236-1498

NPI assigned

Nov 8, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cfullilove@direct.ccprovider.org

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.

• Constance Fullilove, PH.D., LTD.

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1851441984
  Medicare reassignment NPD Authorized official
• Cook County

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1588612832
  Medicare reassignment NPD
• Center for Applied Psychology and Forensic Studies

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1386821551
  NPD Authorized official
• Cook County

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1821385170
  NPD
• Cook County

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1831219450
  NPD
• Constance a Fullilove PHD LTD

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1932022134
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619136000000",
    "number": "1235209529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W RANDOLPH ST STE 830",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606061815",
            "telephone_number": "312-236-1498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W RANDOLPH ST STE 830",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606061815",
            "telephone_number": "312-236-1498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLILOVE",
        "first_name": "CONSTANCE",
        "middle_name": "ANITA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-002239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cfullilove@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.