Active NPI
Mario Vincent Raines, MSW, LSW
- Social Worker
- Oak Park, IL
National Provider Identifier
1851979504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150.104589
- Practice address
- 1010 Lake St
Oak Park, IL 60301-1147 - Phone
- (630) 428-7890
- NPI assigned
- Apr 1, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150.104589 | IL | Primary |
Addresses
Primary practice location
1010 Lake St
Oak Park, IL 60301-1147
Mailing address
7500 W Jonquil Ter
Niles, IL 60714-3106
Phone (847) 721-1870
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150.104589 | Other | IL | SOCIAL WORK LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Mario.Raines@lifestance.com | Direct |
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 |
|---|---|---|---|
| 150.104589 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgewood Clinical Services, P.C. | Past | Accepting new patients |
Interoperability endpoints
- mario.raines@lifestance.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Naperville, IL
- NPI 1295914646
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617235200000",
"number": "1851979504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7500 W JONQUIL TER",
"city": "NILES",
"state": "IL",
"postal_code": "607143106",
"telephone_number": "847-721-1870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 LAKE ST",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011147",
"telephone_number": "630-428-7890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAINES",
"first_name": "MARIO",
"middle_name": "VINCENT",
"credential": "MSW, LSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-01",
"last_updated": "2021-04-01",
"certification_date": "2021-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150.104589",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOCIAL WORK LICENSE",
"identifier": "150.104589",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Mario.Raines@lifestance.com",
"affiliation": "N",
"endpointDescription": "Work Email",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1010 Lake St",
"city": "Oak Park",
"state": "IL",
"country_code": "US",
"postal_code": "603011147",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.