NPIMap

Organization Active NPI

Jamie Mirocha

  • Clinical Social Worker
  • Plainfield, IL
National Provider Identifier
1720463847
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149017464 Issued in IL
Legal business name
JAMIE MIROCHA
Practice address
24012 W Renwick Rd Ste 204a
Plainfield, IL 60544-8733
Phone
(815) 676-4688
Fax
(815) 676-4498
NPI assigned
Jul 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

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

Authorized official

Name
Mrs. Jamie Mirocha, LCSW, CADC
Title
Licensed Clinical Social Worker
Phone
(815) 676-4688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 149017464 IL Primary

Addresses

Primary practice location

24012 W Renwick Rd Ste 204a
Plainfield, IL 60544-8733

Mailing address

24012 W Renwick Rd Ste 204a
Plainfield, IL 60544-8733
Phone (815) 676-4688

National Provider Directory

National Provider Directory

Locations

24012 W Renwick Rd
Ste 204A
Plainfield, IL 60544
Phone (815) 676-4688

NPI Registry JSON

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

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438214400000",
    "number": "1720463847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24012 W RENWICK RD STE 204A",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605448733",
            "telephone_number": "815-676-4688",
            "fax_number": "815-676-4498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24012 W RENWICK RD STE 204A",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605448733",
            "telephone_number": "815-676-4688",
            "fax_number": "815-676-4498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMIE MIROCHA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-30",
        "last_updated": "2015-07-30",
        "status": "A",
        "authorized_official_last_name": "MIROCHA",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "815-676-4688",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW, CADC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149017464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; 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.