Mary Eileen O'Sullivan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.024800 Issued in IL

Practice address

905 Manley Rd
St Charles, IL 60174-5561

Phone

(630) 624-9620

NPI assigned

Dec 27, 2022

Last updated

May 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Eileen O'Sullivan Former name

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1672099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1417660168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 MANLEY RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745561",
            "telephone_number": "630-624-9620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 MANLEY RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745561",
            "telephone_number": "630-624-9620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'SULLIVAN",
        "first_name": "MARY",
        "middle_name": "EILEEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-27",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.024800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "O'SULLIVAN",
            "middle_name": "EILEEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in St Charles, IL
• Providers in St Charles, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.