Active NPI
Phyllis Goldberg Maciulis, LCSW
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1396956538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.008545
- Practice address
- 1801 W 21St PL
Chicago, IL 60608-4305 - Phone
- (312) 218-6627
- Fax
- (312) 506-0103
- NPI assigned
- May 25, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.008545 | IL | Primary |
Addresses
Primary practice location
1801 W 21St PL
Chicago, IL 60608-4305
Mailing address
1801 W 21St PL
Chicago, IL 60608-4305
Phone (312) 218-6627
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1975
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1801 W 21St PL
Chicago, IL 60608-4305
1801 W 21St Place
Chicago, IL 60608-4305
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.008545 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429574400000",
"number": "1396956538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 W 21ST PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606084305",
"telephone_number": "312-218-6627",
"fax_number": "312-506-0103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 W 21ST PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606084305",
"telephone_number": "312-218-6627",
"fax_number": "312-506-0103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACIULIS",
"first_name": "PHYLLIS",
"middle_name": "GOLDBERG",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-25",
"last_updated": "2015-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.008545",
"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 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.