Individual provider Active NPI

Anna Maria Avery, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1386615268
Registry record updated Feb 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149011461 Issued in IL
Practice address
77 W Washington St Ste 1910
Chicago, IL 60602-3176
Phone
(312) 607-1263
Fax
(312) 313-8998
NPI assigned
Jan 30, 2006
Last updated
Feb 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149011461 IL Primary

Addresses

Primary practice location

77 W Washington St Ste 1910
Chicago, IL 60602-3176

Mailing address

77 W Washington St Ste 1910
Chicago, IL 60602-3176
Phone (312) 607-1263

Other practice location 1

651 W Buena Ave Apt 1E
Chicago, IL 60613-5662
Phone (312) 607-1263

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060217000469 IL Practitioner - Clinical Social Worker 4284649831 Practice locations: Chicago, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

77 W Washington St
Suite 1910
Chicago, IL 60602-3176
Phone (312) 607-1263

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149011461ILMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708214400000",
    "number": "1386615268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W WASHINGTON ST STE 1910",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023176",
            "telephone_number": "312-607-1263",
            "fax_number": "312-313-8998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W WASHINGTON ST STE 1910",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023176",
            "telephone_number": "312-607-1263",
            "fax_number": "312-313-8998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "651 W Buena Ave Apt 1E",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606135662",
            "country_code": "US",
            "telephone_number": "312-607-1263",
            "fax_number": "312-333-8998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVERY",
        "first_name": "ANNA",
        "middle_name": "MARIA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2024-02-18",
        "certification_date": "2024-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149011461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.