Active NPI
Patricia Joan Ely, LCSW
- Clinical Social Worker
- Geneva, IL
National Provider Identifier
1700417045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.005969
- Practice address
- 28 S 5TH St
Geneva, IL 60134-2111 - Phone
- (630) 587-1163
- NPI assigned
- Jan 27, 2020
- 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 | 149.005969 | IL | Primary |
Addresses
Primary practice location
28 S 5TH St
Geneva, IL 60134-2111
Mailing address
5N317 Hawkins LN
St Charles, IL 60175-6148
Phone (630) 587-1163
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 |
|---|---|---|---|
| 149.005969 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580083200000",
"number": "1700417045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5N317 HAWKINS LN",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601756148",
"telephone_number": "630-587-1163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 S 5TH ST",
"city": "GENEVA",
"state": "IL",
"postal_code": "601342111",
"telephone_number": "630-587-1163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELY",
"first_name": "PATRICIA",
"middle_name": "JOAN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-27",
"last_updated": "2020-01-27",
"certification_date": "2020-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.005969",
"primary": true
}
],
"identifiers": [],
"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 Jan 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.