Interlude Wellness PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

INTERLUDE WELLNESS PLLC

Practice address

1125 Franklin St
Downers Grove, IL 60515-3551

Phone

(630) 247-1978

NPI assigned

Jul 23, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Cornelius Francis Gorman III, LCSWNPI 1669723284

Title

Clinical Director & Therapist

Phone

(630) 247-1978

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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

• Cornelius Francis Gorman III, LCSW

  • Clinical Social Worker
  • Downers Grove, IL
  • NPI 1669723284
  Medicare reassignment Authorized official
• Jared Elwart, LCSW

  • Social Worker
  • Downers Grove, IL
  • NPI 1164193876
  NPD

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736467200000",
    "number": "1285207571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 FRANKLIN ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605153551",
            "telephone_number": "630-247-1978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 FRANKLIN ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605153551",
            "telephone_number": "630-247-1978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERLUDE WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-23",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A",
        "authorized_official_last_name": "GORMAN",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_middle_name": "FRANCIS",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR & THERAPIST",
        "authorized_official_telephone_number": "630-247-1978",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; 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.