Mary C. Fairchild, LCSW, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.010948 Issued in IL

Legal business name

MARY C. FAIRCHILD, LCSW, LLC

Practice address

5301 E State St Ste 202
Rockford, IL 61108-2392

Phone

(815) 520-6676

Fax

(866) 724-9612

NPI assigned

Apr 6, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary C Fairchild, LCSW

Title

Owner

Phone

(815) 520-6676

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1428278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428451200000",
    "number": "1629463641",
    "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": "5301 E STATE ST STE 202",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082392",
            "telephone_number": "815-520-6676",
            "fax_number": "866-724-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY C. FAIRCHILD, LCSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-06",
        "last_updated": "2015-04-08",
        "status": "A",
        "authorized_official_last_name": "FAIRCHILD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-520-6676",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.010948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marco Antonio Martinez, MD
• Maria P. Martinez, MD
• Steven Eugene Martinson, RPH
• Kristen Lynn Marvel
• Lindsay Marvick
• Mary C. Gurney, PC
• Mary Petro LCSW PLLC
• Angela Rose Mascharka, L.C.S.W.
• Andrew J Masterson, PA-C
• Masterton Billing, LLC

• 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 Apr 8, 2015; 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.