Matthew Staley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149021089 Issued in IL

Practice address

25480 W Cedar Crest LN
Lake Villa, IL 60046-9744

Phone

(847) 356-8205

NPI assigned

Jan 9, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578528000000",
    "number": "1770123671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E JACKSON BLVD STE 1500",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606044184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25480 W CEDAR CREST LN",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600469744",
            "telephone_number": "847-356-8205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "MATTHEW",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-09",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149021089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS",
            "identifier": "149021089",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Simmons, OT
• Colleen Skotnicki, PT
• Sleepwatchers, PLLC
• Sleepwatchers, PLLC
• Michael Smith, LSW
• Mia L Standerski, ATC
• William Eugene Swarner, LMT
• James William Swenson, D.D.S.
• Eevon Swilley, LSW
• Patricia Ann Taglione, PSY. D.

• Clinical Social Worker in Lake Villa, IL
• Providers in Lake Villa, 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 Jan 9, 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.

Verify at the official NPI Registry.