Active NPI
Daniel Serpa, LCSW
- Clinical Social Worker
- Evanston, IL
National Provider Identifier
1578865945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149014309
- Practice address
- 708 Church St Ste 233
Evanston, IL 60201-3885 - Phone
- (773) 414-3663
- NPI assigned
- Nov 17, 2010
- Sex
- Male
- 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 | 149014309 | IL | Primary |
Addresses
Primary practice location
708 Church St Ste 233
Evanston, IL 60201-3885
Mailing address
2730 Sheridan Rd
Evanston, IL 60201-1754
Phone (773) 414-3663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149014309 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578873600000",
"number": "1578865945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2730 SHERIDAN RD",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011754",
"telephone_number": "773-414-3663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "708 CHURCH ST STE 233",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602013885",
"telephone_number": "773-414-3663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERPA",
"first_name": "DANIEL",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-17",
"last_updated": "2020-01-13",
"certification_date": "2020-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149014309",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.