NPIMap

Organization Active NPI

Forge Psychology Chicago, PLLC

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1326828278
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
FORGE PSYCHOLOGY CHICAGO, PLLC
Practice address
1331 N Bosworth Ave Apt 3
Chicago, IL 60642-3421
Phone
(773) 683-3200
NPI assigned
Sep 28, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Dr. Jackson Newsome, PSYDNPI 1740944438
Title
Licensed Clinical Psychologist
Phone
(773) 683-3200

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 PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1331 N Bosworth Ave Apt 3
Chicago, IL 60642-3421

Mailing address

1331 N Bosworth Ave Apt 3
Chicago, IL 60642-3421
Phone (773) 683-3200

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1695859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1326828278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 N BOSWORTH AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606423421",
            "telephone_number": "773-683-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 N BOSWORTH AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606423421",
            "telephone_number": "773-683-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORGE PSYCHOLOGY CHICAGO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-28",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "NEWSOME",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "773-683-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "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 Sep 28, 2023; 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.