Active NPI
Therese Otoole, LICSW
- Clinical Social Worker
- Evanston, IL
National Provider Identifier
1679353403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 089.0135349
- Practice address
- 618 Elmwood Ave Apt 1
Evanston, IL 60202-4129 - Phone
- (630) 337-6161
- NPI assigned
- Sep 29, 2023
- Sex
- Female
- 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 | 089.0135349 | VT | Primary |
Addresses
Primary practice location
618 Elmwood Ave Apt 1
Evanston, IL 60202-4129
Mailing address
618 Elmwood Ave Apt 1
Evanston, IL 60202-4129
Phone (630) 337-6161
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089.0135349 | VT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695945600000",
"number": "1679353403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "618 ELMWOOD AVE APT 1",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602024129",
"telephone_number": "630-337-6161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "618 ELMWOOD AVE APT 1",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602024129",
"telephone_number": "630-337-6161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTOOLE",
"first_name": "THERESE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-29",
"last_updated": "2023-09-29",
"certification_date": "2023-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "089.0135349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.