Chicago Midway Youth Center

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CHICAGO MIDWAY YOUTH CENTER

Practice address

4051 W 63Rd St
Chicago, IL 60629-4638

Phone

(773) 742-5728

NPI assigned

Feb 24, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Sandra Mosqueda, LCSWNPI 1912410366

Title

Behavioral Health Therapist

Phone

(773) 742-5728

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sandra Mosqueda, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1912410366
  NPD Authorized official

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1497401855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 9TH AVE",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605256728",
            "telephone_number": "773-742-5728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4051 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606294638",
            "telephone_number": "773-742-5728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO MIDWAY YOUTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "MOSQUEDA",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH THERAPIST",
        "authorized_official_telephone_number": "773-742-5728",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "ChicagoMidwayYouthCenterLLC",
            "affiliation": "N",
            "address_1": "4051 W 63rd St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606294638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Chicago, IL
• Providers in Chicago, 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 Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.