Alex Balmore Quintanilla, LCSW 84870

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.023430 Issued in IL

Practice address

44 E Main St Ste 406
Champaign, IL 61820-3649

Phone

(217) 615-0350

NPI assigned

Apr 9, 2008

Last updated

Jul 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Constructive Changes Licensed Clinical Social Worker Services

  • Community/Behavioral Health Agency
  • Champaign, IL
  • NPI 1417630757
  NPD Authorized official

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1568635613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 W KIRBY AVE UNIT 306",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215507",
            "telephone_number": "217-615-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 E MAIN ST STE 406",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203649",
            "telephone_number": "217-615-0350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 E John St",
            "address_purpose": "LOCATION",
            "city": "Champaign",
            "state": "IL",
            "postal_code": "618205717",
            "country_code": "US",
            "telephone_number": "217-333-3704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUINTANILLA",
        "first_name": "ALEX",
        "middle_name": "BALMORE",
        "credential": "LCSW 84870",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "84870",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.023430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Chugh Qualls, OD
• Quednau Hearing. Inc (Quednau Hearing)
• Theresa Quednau
• Ann Marlyn Quiban
• Erika Quinn, MSW
• Karina Quinto Vazquez, FNP-C
• Julie Linn Quivey, O.D.
• Paige E Raab, PT
• Chris Rabe
• Jill Marie Rackow, CD(DONA)

• Clinical Social Worker in Champaign, IL
• Providers in Champaign, 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 Jul 14, 2023; 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.