Ivy Fay Malisow, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180011204 Issued in IL

Practice address

101 Madison St
Oak Park, IL 60302-4278

Phone

(708) 859-8004

NPI assigned

May 14, 2018

Last updated

May 14, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Root & Vines Wellness, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1013774587
  NPD Authorized official
• Uhs of Hartgrove, Inc

  dba Oak Park Counseling Center

  • Child & Adolescent Psychiatry Physician
  • Oak Park, IL
  • NPI 1396981627
  NPD (past)
• Uhs of Hartgrove, Inc

  dba UHS of Hartgrove-Chatham Counseling Center

  • Child & Adolescent Psychiatry Physician
  • Chicago, IL
  • NPI 1538560339
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1710477823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 N RACINE AVE BSMT",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606574223",
            "telephone_number": "505-331-3467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MADISON ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603024278",
            "telephone_number": "708-859-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALISOW",
        "first_name": "IVY",
        "middle_name": "FAY",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-14",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180011204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashok Kumar Maini
• Lisa M Makely, LCSW
• Malachite Institute for Behavioral Health, Inc
• Malcolm a Deam MD & Associates SC
• Deisy Maldonado
• James Joseph Mancuso, LCPC
• Sabrina Gail Mandelbaum, M.A., CCC-SLP
• Lacey Manimala
• Aliya Manjarrez
• Janet Marie Mankoff

• Professional Counselor in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.