Active NPI
Elissa McGovern
- Clinical Psychologist
- Carol Stream, IL
National Provider Identifier
1861840696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.009740
- Practice address
- 507 Thornhill Dr
Carol Stream, IL 60188 - Phone
- (630) 752-9750
- NPI assigned
- Jun 2, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.009740 | IL | Primary |
Addresses
Primary practice location
507 Thornhill Dr
Carol Stream, IL 60188
Mailing address
507 Thornhill Dr
Carol Stream, IL 60188-2706
Phone (630) 752-9750
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.009740 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533513600000",
"number": "1861840696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "507 THORNHILL DR",
"city": "CAROL STREAM",
"state": "IL",
"postal_code": "601882706",
"telephone_number": "630-752-9750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "507 THORNHILL DR",
"city": "CAROL STREAM",
"state": "IL",
"postal_code": "60188",
"telephone_number": "630-752-9750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGOVERN",
"first_name": "ELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-02",
"last_updated": "2018-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.009740",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carol Stream, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.