Active NPI
Jacqueline Carmody
- Mental Health Counselor
- Chicago, IL
National Provider Identifier
1265895577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 180010042
- Practice address
- 1579 N Milwaukee Ave
Chicago, IL 60622-2452 - Phone
- (872) 233-8808
- NPI assigned
- Apr 4, 2016
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180010042 | IL | Primary |
Addresses
Primary practice location
1579 N Milwaukee Ave
Chicago, IL 60622-2452
Mailing address
4032 N Ashland Ave
Chicago, IL 60613-2503
Phone (708) 308-5787
Other practice location 1
6852 W Evergreen Ave
Palos Heights, IL 60463-2124
Phone (708) 308-5787
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 29, 2024 through Mar 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180010042 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740441600000",
"number": "1265895577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4032 N ASHLAND AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606132503",
"telephone_number": "708-308-5787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1579 N MILWAUKEE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606222452",
"telephone_number": "872-233-8808"
}
],
"practiceLocations": [
{
"address_1": "6852 W Evergreen Ave",
"address_purpose": "LOCATION",
"city": "Palos Heights",
"state": "IL",
"postal_code": "604632124",
"country_code": "US",
"telephone_number": "708-308-5787",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARMODY",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-04",
"last_updated": "2025-02-25",
"certification_date": "2025-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180010042",
"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 Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.