Active NPI
Matthew Edward Cermak, MSW LSW CADC MISA-1
- Social Worker
- Geneva, IL
National Provider Identifier
1679958011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150015736
- Practice address
- 2631 Williamsburg Ave
Suite 302
Geneva, IL 60134-1107 - Phone
- (815) 520-1181
- NPI assigned
- Jul 28, 2015
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 32399 | IL | |
| Social Worker | 104100000X | 150015736 | IL | Primary |
Addresses
Primary practice location
2631 Williamsburg Ave
Suite 302
Geneva, IL 60134-1107
Mailing address
2631 Williamsburg Ave
Suite 302
Geneva, IL 60134
Phone (815) 520-1181
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3884947 | Other | IL | FEIN |
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 |
|---|---|---|---|
| 32399 | IL | MD | Addiction (Substance Use Disorder) Counselor |
| 150015736 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438041600000",
"number": "1679958011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2631 WILLIAMSBURG AVE",
"address_2": "SUITE 302",
"city": "GENEVA",
"state": "IL",
"postal_code": "60134",
"telephone_number": "815-520-1181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2631 WILLIAMSBURG AVE",
"address_2": "SUITE 302",
"city": "GENEVA",
"state": "IL",
"postal_code": "601341107",
"telephone_number": "815-520-1181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERMAK",
"first_name": "MATTHEW",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "MSW LSW CADC MISA-1",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-28",
"last_updated": "2015-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IL",
"license": "32399",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150015736",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEIN",
"identifier": "3884947",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Geneva, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.