The Videri Clinic for Emotional Health PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THE VIDERI CLINIC FOR EMOTIONAL HEALTH PLLC

Practice address

207 E Ohio St # 386
Chicago, IL 60611-4092

Phone

(708) 351-8212

NPI assigned

Feb 20, 2022

Organization subpart

No

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

Authorized official

Name

Fernando Gonzalez IIINPI 1891273900

Title

Founder and Director

Phone

(708) 351-8212

Specialties & licenses 2

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fernando Gonzalez III, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1891273900
  NPD Authorized official

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

{
    "created_epoch": "1645315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645315200000",
    "number": "1760137558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 E OHIO ST # 386",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E OHIO ST # 386",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114092",
            "telephone_number": "708-351-8212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VIDERI CLINIC FOR EMOTIONAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-20",
        "last_updated": "2022-02-20",
        "certification_date": "2022-02-20",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "FERNANDO",
        "authorized_official_title_or_position": "FOUNDER AND DIRECTOR",
        "authorized_official_telephone_number": "708-351-8212",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.videriclinic.com",
            "affiliation": "N",
            "address_1": "207 E Ohio St # 386",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606114092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2022; 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.