Robin Moore, LCSW
Individual provider Active NPI Clinical Social Worker · Burnham, IL
NPI 1376097725 · NPPES record last updated Aug 14, 2016
Key facts
- NPI
- 1376097725
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149017272 (IL)
- Practice address
- 2700 E State St
1W
Burnham, IL 60633-2032 - Phone
- (773) 387-7153
- NPI assigned
- Aug 14, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18692 | IL | MD | Addiction (Substance Use Disorder) Counselor |
| 149017272 | IL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 18692 | IL | |
| Clinical Social Worker | 1041C0700X | 149017272 | IL | Yes |
Addresses
Primary practice location
2700 E State St
1W
Burnham, IL 60633-2032
Mailing address
2700 E State St
1W
Burnham, IL 60633-2032
Phone (773) 387-7153
Other providers in Burnham, IL
- Tywanda Jiles
- Katisha Johnson
- Toya Elaine Johnson
- Sharron Lynese McKee
- Jiny M Moller
- Nexus at River Oaks, LLC
- Ronald Paetsch I
- Recor Transportation
- River Oaks Healthcare & Rehabilitation Center, LP
- Roy W Hallman
All providers in Burnham, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.