Active NPI
Lawrence Michael Wieczorek, LCSW
- Clinical Social Worker
- Western Springs, IL
National Provider Identifier
1598864035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 901 Burlington Ave
Suite 3
Western Springs, IL 60558-1575 - Phone
- (630) 969-2810
- Fax
- (630) 969-2810
- NPI assigned
- Sep 21, 2006
- 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 | IL | Primary |
Addresses
Primary practice location
901 Burlington Ave
Suite 3
Western Springs, IL 60558-1575
Mailing address
901 Burlington Ave
Suite 3
Western Springs, IL 60558-1575
Phone (630) 969-2810
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04971454 | Other | IL | BLUE CROSS BLUE SHIELD |
| 02273040 | Other | IL | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598864035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 BURLINGTON AVE",
"address_2": "SUITE 3",
"city": "WESTERN SPRINGS",
"state": "IL",
"postal_code": "605581575",
"telephone_number": "630-969-2810",
"fax_number": "630-969-2810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 BURLINGTON AVE",
"address_2": "SUITE 3",
"city": "WESTERN SPRINGS",
"state": "IL",
"postal_code": "605581575",
"telephone_number": "630-969-2810",
"fax_number": "630-969-2810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIECZOREK",
"first_name": "LAWRENCE",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "04971454",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "02273040",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Western Springs, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.