Active NPI
Daniel Suffoletta II
- Mental Health Counselor
- Chicago, IL
National Provider Identifier
1366130452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MC61421143
- Practice address
- 1731 N Marcey St Ste 510
Chicago, IL 60614-7955 - Phone
- (773) 538-3996
- NPI assigned
- Apr 26, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC61421143 | WA | Primary |
Addresses
Primary practice location
1731 N Marcey St Ste 510
Chicago, IL 60614-7955
Mailing address
2741 N Mildred Ave Apt 2N
Chicago, IL 60614-8147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 5, 2024 through Nov 5, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC61421143 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682467200000",
"number": "1366130452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2741 N MILDRED AVE APT 2N",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606148147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1731 N MARCEY ST STE 510",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606147955",
"telephone_number": "773-538-3996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUFFOLETTA",
"first_name": "DANIEL",
"name_suffix": "II",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-26",
"last_updated": "2023-04-26",
"certification_date": "2023-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MC61421143",
"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 Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.