Mary C Bruell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149008927 Issued in IL

Practice address

Dept of Psychiatry
221 NE Glen Oak 7 West
Peoria, IL 61636-0001

Phone

(309) 671-8222

NPI assigned

Feb 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Chris Bruell Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Board of Trustees of the University of Illinois

  • Pediatrics Physician
  • Peoria, IL
  • NPI 1467425322
  NPD (past)
• University of Illinois

  • Pediatric Neurodevelopmental Disabilities Physician
  • Peoria, IL
  • NPI 1174596225
  NPD (past)
• University of Illinois

  • Pediatric Critical Care Medicine Physician
  • Peoria, IL
  • NPI 1205807187
  NPD (past)
• University of Illinois

  • Psychiatry Physician
  • Peoria, IL
  • NPI 1245203280
  NPD (past)
• University of Illinois

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1255301909
  NPD (past)
• University of Illinois

  • Pediatric Hematology & Oncology Physician
  • Peoria, IL
  • NPI 1568433050
  NPD (past)
• University of Illinois

  • Developmental - Behavioral Pediatrics Physician
  • Peoria, IL
  • NPI 1619948411
  NPD (past)
• University of Illinois

  • Obstetrics & Gynecology Physician
  • Peoria, IL
  • NPI 1962475996
  NPD (past)

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259107200000",
    "number": "1659345007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ILLINI DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052576",
            "telephone_number": "309-671-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPT OF PSYCHIATRY",
            "address_2": "221 NE GLEN OAK 7 WEST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616360001",
            "telephone_number": "309-671-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUELL",
        "first_name": "MARY",
        "middle_name": "C",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-14",
        "last_updated": "2009-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149008927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07215036",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRIS",
            "last_name": "BRUELL",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Regina Marie Brown, MD
• Swannita Ann Brown, COTA/L
• Timothy Brown, APRN
• Wendy Alleen Brown, LCSW
• Tim Bruce, PHD
• Jana Bruesch, PT
• Kayla Anne Brugger
• Bruketa Family Chiropractic
• Kyle Bruketa, D.C.
• William Kevin Brummitt, RPH

• Clinical Social Worker in Peoria, IL
• Providers in Peoria, 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 Nov 25, 2009; 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.