NPIMap

Organization Active NPI

Corey & Cynthia F. Dabney Behavioral Health Hospital

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1255804167
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
COREY & CYNTHIA F. DABNEY BEHAVIORAL HEALTH HOSPITAL
Practice address
845 W 69TH Street
Lower Level
Chicago, IL 60621-1709
Phone
(917) 618-4042
NPI assigned
Jan 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Authorized official

Name
Prof. Corey Dabney, QMHP, MBA, M.S.NPI 1447856240
Title
Ceo and Chairman
Phone
(917) 618-4042

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychoanalystGroup: 193200000X MULTI-SPECIALTY GROUP 102L00000X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X

Addresses

Primary practice location

845 W 69TH Street
Lower Level
Chicago, IL 60621-1709

Mailing address

845 W 69TH Street
Lower Level
Chicago, IL 60621-1709
Phone (917) 618-4042

Other names 1

  • Dabney Behavioral Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191024001924 IL Part B Supplier - Clinic/Group Practice 5294067237 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Chicago, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Corey Cynthia F Dabney Behavioral Health Hospital2 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

845 W 69th St
Lowr
Chicago, IL 60621
Phone (224) 347-4875

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1255804167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 W 69TH STREET",
            "address_2": "LOWER LEVEL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606211709",
            "telephone_number": "917-618-4042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 W 69TH STREET",
            "address_2": "LOWER LEVEL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606211709",
            "telephone_number": "917-618-4042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COREY & CYNTHIA F. DABNEY BEHAVIORAL HEALTH HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-03",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "DABNEY",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "CEO AND CHAIRMAN",
        "authorized_official_telephone_number": "917-618-4042",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "QMHP, MBA, M.S."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "102L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychoanalyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dabney Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dabney Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 23, 2019; 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.