Active NPI
Mariette Champagne, LCSW, CADC
- Clinical Social Worker
- Northbrook, IL
National Provider Identifier
1710347455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149017947
- Practice address
- 60 Revere Dr
Suite 202
Northbrook, IL 60062-1563 - Phone
- (847) 650-9701
- NPI assigned
- Feb 23, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 31532 | IL | |
| Clinical Social Worker | 1041C0700X | 149017947 | IL | Primary |
Addresses
Primary practice location
60 Revere Dr
Suite 202
Northbrook, IL 60062-1563
Mailing address
60 Revere Dr
Suite 202
Northbrook, IL 60062-1563
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 |
|---|---|---|---|
| 31532 | IL | MD | Addiction (Substance Use Disorder) Counselor |
| 149017947 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456185600000",
"number": "1710347455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 REVERE DR",
"address_2": "SUITE 202",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 REVERE DR",
"address_2": "SUITE 202",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621563",
"telephone_number": "847-650-9701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMPAGNE",
"first_name": "MARIETTE",
"credential": "LCSW, CADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-23",
"last_updated": "2016-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IL",
"license": "31532",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149017947",
"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 Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.