Active NPI
Brandis Diane Smith, LSW
- Social Worker
- Bolingbrook, IL
National Provider Identifier
1235647579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150.101376
- Practice address
- 440 W Boughton Rd Ste 104
Bolingbrook, IL 60440-1400 - Phone
- (331) 318-1818
- NPI assigned
- Jan 22, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150.101376 | IL | Primary |
Addresses
Primary practice location
440 W Boughton Rd Ste 104
Bolingbrook, IL 60440-1400
Mailing address
15 S Eastern Ave Unit 3
Joliet, IL 60433-1038
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
| License | State | Type | Specialty |
|---|---|---|---|
| 150.101376 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516579200000",
"number": "1235647579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 S EASTERN AVE UNIT 3",
"city": "JOLIET",
"state": "IL",
"postal_code": "604331038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 W BOUGHTON RD STE 104",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604401400",
"telephone_number": "331-318-1818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "BRANDIS",
"middle_name": "DIANE",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-22",
"last_updated": "2018-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150.101376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.