Mary C Fairchild, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149010948 Issued in IL

Practice address

6072 Brynwood Dr Ste 201
Rockford, IL 61114-5829

Phone

(815) 520-6676

Fax

(866) 724-9612

NPI assigned

Aug 25, 2006

Last updated

Sep 23, 2019By 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 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Mary C. Fairchild, LCSW, LLC

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1629463641
  Authorized official Same address or phone

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1588771265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2618 CERRO VISTA DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071008",
            "telephone_number": "815-520-6676",
            "fax_number": "866-724-9612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6072 BRYNWOOD DR STE 201",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145829",
            "telephone_number": "815-520-6676",
            "fax_number": "866-724-9612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "461 North Mulford Road",
            "address_2": "Suite 11",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "61107",
            "country_code": "US",
            "telephone_number": "815-398-8443",
            "fax_number": "815-399-1959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRCHILD",
        "first_name": "MARY",
        "middle_name": "C",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.010948",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149010948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH CORP",
            "identifier": "242733",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "10132126",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Benjamin Eytalis
• April Faas
• Facchiano & Associates PC
• Vincent R Facchiano, OD
• Yazan Fahmawi, MD
• Fairhaven Christian Retirement Center
• Fairview Nursing Plaza, Inc.
• Chelsea Jean Falconer, PT, DPT, ATC, CSCS
• Sherry A Falsetti, PHD
• Sean Falsey

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, 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 Sep 23, 2019; 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.