Active NPI
Rebecca Anne Gadomski, LSW, LCSW
- Clinical Social Worker
- Naperville, IL
National Provider Identifier
1255455838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149011718
- Practice address
- 2948 Artesian Rd Ste 112
Naperville, IL 60564-8559 - Phone
- (630) 428-7890
- Fax
- (630) 428-7891
- NPI assigned
- Mar 19, 2007
- Last updated
- Jan 15, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149011718 | IL | Primary |
Addresses
Primary practice location
2948 Artesian Rd Ste 112
Naperville, IL 60564-8559
Mailing address
8S744 Wayewood LN
Naperville, IL 60565-9232
Phone (630) 873-9052
Other names 1
- Rebecca Anne Wiet
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149011718 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychology Specialists LTD | Clinical | Past | Accepting new patients |
| Edgewood Clinical Services, P.C. | Past | Accepting new patients |
Interoperability endpoints
- lifestancehealth.rebeccagadomski@146897.advancedmd-direct.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba LifeStance
- Community/Behavioral Health Agency
- Naperville, IL
- NPI 1366784837
-
dba LifeStance Health
- Clinical Psychologist
- Bloomington, IL
- NPI 1053368605
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673740800000",
"number": "1255455838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8S744 WAYEWOOD LN",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605659232",
"telephone_number": "630-873-9052",
"fax_number": "630-428-7891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2948 ARTESIAN RD STE 112",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605648559",
"telephone_number": "630-428-7890",
"fax_number": "630-428-7891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GADOMSKI",
"first_name": "REBECCA",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "LSW, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2023-01-15",
"certification_date": "2023-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149011718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "REBECCA",
"last_name": "WIET",
"middle_name": "ANNE",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.