NPIMap

Organization Active NPI

Center for Grief Recovery and Sibling Loss

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1316046386
Registry record updated Oct 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149-006624 Issued in IL
Legal business name
CENTER FOR GRIEF RECOVERY AND SIBLING LOSS
Practice address
1263 W Loyola Ave
Chicago, IL 60626-5101
Phone
(773) 274-4600
NPI assigned
Sep 22, 2006
Last updated
Oct 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2009

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

Authorized official

Name
Mr. David Michael Fireman, LCSWNPI 1750480745
Title
Executive Director
Phone
(773) 274-4600

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 149-006624 IL Primary

Addresses

Primary practice location

1263 W Loyola Ave
Chicago, IL 60626-5101

Mailing address

1263 W Loyola Ave
Chicago, IL 60626-5101
Phone (773) 274-4600

Other identifiers 1

IdentifierTypeStateIssuer
0001619932OtherILGROUP NUMBER FOR BC/BS-PP

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254787200000",
    "number": "1316046386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1263 W LOYOLA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606265101",
            "telephone_number": "773-274-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 W LOYOLA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606265101",
            "telephone_number": "773-274-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR GRIEF RECOVERY AND SIBLING LOSS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2009-10-06",
        "status": "A",
        "authorized_official_last_name": "FIREMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-274-4600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-006624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NUMBER FOR BC/BS-PP",
            "identifier": "0001619932",
            "state": "IL"
        }
    ],
    "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 Oct 6, 2009; 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.