Active NPI
John Myron Netherly, MSW
- Social Worker
- Melrose Park, IL
National Provider Identifier
1588936843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 36-2709982
- Practice address
- 1414 Main St
Melrose Park, IL 60160-3902 - Phone
- (708) 715-8109
- NPI assigned
- Feb 2, 2012
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 36-2709982 | IL | Primary |
Addresses
Primary practice location
1414 Main St
Melrose Park, IL 60160-3902
Mailing address
1414 Main St
Melrose Park, IL 60160-3902
Phone (708) 715-8109
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 |
|---|---|---|---|
| 36-2709982 | IL | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328140800000",
"number": "1588936843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 MAIN ST",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601603902",
"telephone_number": "708-715-8109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 MAIN ST",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601603902",
"telephone_number": "708-715-8109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NETHERLY",
"first_name": "JOHN",
"middle_name": "MYRON",
"name_prefix": "Mr.",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-02",
"last_updated": "2012-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "36-2709982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melrose Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.