Active NPI
Mallory R Tamillo, LCSW
- Clinical Social Worker
- Northbrook, IL
National Provider Identifier
1689371254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.026934
- Practice address
- 60 Revere Dr Ste 100
Northbrook, IL 60062-1590 - Phone
- (877) 552-6672
- Fax
- (224) 306-1878
- NPI assigned
- Feb 14, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 149.026934 | IL | Primary |
Addresses
Primary practice location
60 Revere Dr Ste 100
Northbrook, IL 60062-1590
Mailing address
60 Revere Dr Ste 100
Northbrook, IL 60062-1590
Phone (224) 306-1879
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.026934 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728432000000",
"number": "1689371254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 REVERE DR STE 100",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621590",
"telephone_number": "224-306-1879",
"fax_number": "224-306-1878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 REVERE DR STE 100",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621590",
"telephone_number": "877-552-6672",
"fax_number": "224-306-1878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAMILLO",
"first_name": "MALLORY",
"middle_name": "R",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-14",
"last_updated": "2024-10-09",
"certification_date": "2024-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.026934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.