North Shore Resilient Family LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149-009018 Issued in IL

Legal business name

NORTH SHORE RESILIENT FAMILY LLC

Practice address

636 Church St Ste 416
Evanston, IL 60201-4580

Phone

(847) 461-9731

NPI assigned

Mar 23, 2017

Organization subpart

No

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

Authorized official

Name

Mary Alexandra 'Alex Doty, LCSW

Title

Owner/ Clinician

Phone

(847) 461-9731

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• North Shore Resilient Family Former legal business name

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

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505952000000",
    "number": "1891226767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2636 PRAIRIE AVE APT A",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602015743",
            "telephone_number": "847-461-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST STE 416",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014580",
            "telephone_number": "847-461-9731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE RESILIENT FAMILY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-23",
        "last_updated": "2017-09-21",
        "status": "A",
        "authorized_official_last_name": "DOTY",
        "authorized_official_first_name": "MARY ALEXANDRA 'ALEX",
        "authorized_official_title_or_position": "OWNER/ CLINICIAN",
        "authorized_official_telephone_number": "847-461-9731",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149-009018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "00000000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Resilient Family",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Social Worker in Evanston, IL
• Providers in Evanston, 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 Sep 21, 2017; 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.