Active NPI
Jordan Jay Litvak, LICENSED CLINICAL SO
- Clinical Social Worker
- Springfield, IL
National Provider Identifier
1609315662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149-003693
- Practice address
- 2200 Boysenberry LN Apt 2
Springfield, IL 62711-5403 - Phone
- (217) 971-8836
- NPI assigned
- Feb 22, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C-10292 | NM | |
| Clinical Social Worker | 1041C0700X | 149-003693 | IL | Primary |
Addresses
Primary practice location
2200 Boysenberry LN Apt 2
Springfield, IL 62711-5403
Mailing address
2200 Boysenberry LN Apt 2
Springfield, IL 62711-5403
Phone (217) 971-8836
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149-003693 | IL | MD | Clinical Social Worker |
| C-10292 | NM | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1609315662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 BOYSENBERRY LN APT 2",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627115403",
"telephone_number": "217-971-8836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 BOYSENBERRY LN APT 2",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627115403",
"telephone_number": "217-971-8836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LITVAK",
"first_name": "JORDAN",
"middle_name": "JAY",
"name_prefix": "Mr.",
"credential": "LICENSED CLINICAL SO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-22",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "C-10292",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149-003693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.