South Shore Psychiatry and Wellness

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SOUTH SHORE PSYCHIATRY AND WELLNESS

Practice address

600 Holiday Plaza Dr Ste 182B
Matteson, IL 60443-2236

Phone

(312) 650-9685

NPI assigned

Oct 10, 2026

Last updated

Oct 10, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adeline Ogbor, PMHNP-BCNPI 1376469130

Title

Ceo

Phone

(312) 650-9685

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adeline Ogbor, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1376469130
  Authorized official Same address or phone

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

{
    "created_epoch": "1791590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791590400000",
    "number": "1275438244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HOLIDAY PLAZA DR STE 182B",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432236",
            "telephone_number": "312-650-9685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HOLIDAY PLAZA DR STE 182B",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432236",
            "telephone_number": "312-650-9685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE PSYCHIATRY AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-10",
        "last_updated": "2026-10-10",
        "certification_date": "2026-10-10",
        "status": "A",
        "authorized_official_last_name": "OGBOR",
        "authorized_official_first_name": "ADELINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-650-9685",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miah Raven Symone Smith
• Tiffani Smith, LPC
• Victoria B Smith
• Karen A Sobieraj, MSW LCSW BCD
• Augustine Sohn, LCSW
• Southland Care Coordination Partners, Inc.
• Southland Care Coordination Partners, Inc.
• Zoe R Spada, DPT
• Special Care Transportaion
• Kimberly Patrice Spivey, LCSW

• Psychiatric/Mental Health Nurse Practitioner in Matteson, IL
• Providers in Matteson, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.