Active NPI
Mixi Lopez-Corbin
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1417572603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.022368
- Practice address
- 6501 S Promontory Dr
Chicago, IL 60649-1003 - Phone
- (800) 770-2232
- NPI assigned
- Jun 12, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 122589-SW-LICSW | MA | |
| Clinical Social Worker | 1041C0700X | 149.022368 | IL | Primary |
Addresses
Primary practice location
6501 S Promontory Dr
Chicago, IL 60649-1003
Mailing address
1500 Sherman Ave Apt 419
Evanston, IL 60201-4439
Phone (571) 278-5097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 30, 2026 through Jun 30, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.022368 | IL | MD | Clinical Social Worker |
| 122589-SW-LICSW | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595289600000",
"number": "1417572603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 SHERMAN AVE APT 419",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014439",
"telephone_number": "571-278-5097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6501 S PROMONTORY DR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606491003",
"telephone_number": "800-770-2232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ-CORBIN",
"first_name": "MIXI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-12",
"last_updated": "2020-07-21",
"certification_date": "2020-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "122589-SW-LICSW",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.022368",
"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 Jul 21, 2020; 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.