Active NPI
Juanita San Madrigal, MA,LCPC,CSADC
- Professional Counselor
- Berwyn, IL
National Provider Identifier
1699873018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 6711 26TH St
Berwyn, IL 60402-2502 - Phone
- (708) 749-2481
- Fax
- (708) 749-9206
- NPI assigned
- Sep 20, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | IL | Primary |
Addresses
Primary practice location
6711 26TH St
Berwyn, IL 60402-2502
Mailing address
6711 26TH St
Berwyn, IL 60402-2502
Phone (708) 749-2481
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180-001281 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699873018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6711 26TH ST",
"city": "BERWYN",
"state": "IL",
"postal_code": "604022502",
"telephone_number": "708-749-2481",
"fax_number": "708-749-9206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6711 26TH ST",
"city": "BERWYN",
"state": "IL",
"postal_code": "604022502",
"telephone_number": "708-749-2481",
"fax_number": "708-749-9206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADRIGAL",
"first_name": "JUANITA",
"middle_name": "SAN",
"name_prefix": "Ms.",
"credential": "MA,LCPC,CSADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.