NPIMap

Organization Active NPI

Lutheran Social Services of Illinois

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1295951168
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Practice address
4840 W Byron St
Chicago, IL 60641-2712
Phone
(773) 282-7800
Fax
(773) 282-2163
NPI assigned
Apr 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Mr. Gerald Noonan
Title
Chief Financial Officer
Phone
(847) 635-4600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

4840 W Byron St
Chicago, IL 60641-2712

Mailing address

1001 E Touhy Ave
Suite 170
Des Plaines, IL 60018-5801
Phone (847) 635-4600

Other names 1

  • Portage Cragin Psychiatric Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1295951168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E TOUHY AVE",
            "address_2": "SUITE 170",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600185801",
            "telephone_number": "847-635-4600",
            "fax_number": "847-297-3407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 W BYRON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412712",
            "telephone_number": "773-282-7800",
            "fax_number": "773-282-2163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN SOCIAL SERVICES OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "NOONAN",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "847-635-4600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portage Cragin Psychiatric",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 19, 2008; 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.