Active NPI
Sheila N Nissim, L.C.S.W.
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1457418436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 3166 N Lincoln Ave
#214A
Chicago, IL 60657-3133 - Phone
- (773) 209-5788
- NPI assigned
- Jan 2, 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 | IL | Primary |
Addresses
Primary practice location
3166 N Lincoln Ave
#214A
Chicago, IL 60657-3133
Mailing address
1431 W Granville Ave
#3
Chicago, IL 60660-1809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2023 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149-010372 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457418436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1431 W GRANVILLE AVE",
"address_2": "#3",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606601809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3166 N LINCOLN AVE",
"address_2": "#214A",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606573133",
"telephone_number": "773-209-5788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISSIM",
"first_name": "SHEILA",
"middle_name": "N",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": null,
"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 8, 2007; 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.