Eilis M Fagan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.023436 Issued in IL

Practice address

5646 N Wayne Ave Apt 3
Chicago, IL 60660-0090

Phone

(708) 408-4003

NPI assigned

Dec 10, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Eilis M. Fagan, LCSW PLLC

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1679259881
  NPD Authorized official

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1659918571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5646 N WAYNE AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606600090",
            "telephone_number": "708-408-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5646 N WAYNE AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606600090",
            "telephone_number": "708-408-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "EILIS",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-10",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150104048",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.023436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colin Fadzen, MD PHD
• Danette Fadzl, MEDICAL BILLING
• Patricia Faerber, PT, DPT
• Mariaelena J. Fagadore, CNP
• Brian J Fagan
• Elyse Fagan, CNS, IBCLC
• Marc Fagan, PSY.D.
• Mitchell Fagan, DO
• Kehinde Christiana Fagbemi, NP
• Oladipo Fagbemi, MD

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, 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 Jun 9, 2023; 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.