NPIMap

Organization Active NPI

Mind Chicago

  • Adolescent and Children Mental Health Clinic/Center
  • Chicago, IL
National Provider Identifier
1912549676
Registry record updated Apr 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
MIND CHICAGO
Practice address
4411 N Ravenswood Ave Ste 225
Chicago, IL 60640-5802
Phone
(312) 667-3775
NPI assigned
Oct 15, 2019
Last updated
Apr 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2023

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

Authorized official

Name
Dr. David A Meyerson, PHDNPI 1245671841
Title
Executive Director
Phone
(312) 667-3775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary
Clinical Neuropsychologist 103G00000X NU
Clinical Child & Adolescent Psychologist 103TC2200X NU
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

4411 N Ravenswood Ave Ste 225
Chicago, IL 60640-5802

Mailing address

4411 N Ravenswood Ave Ste 225
Chicago, IL 60640-5802
Phone (312) 667-3775

National Provider Directory

National Provider Directory

Locations

4411 N Ravenswood Ave
Ste 225
Chicago, IL 60640
Phone (312) 667-3775

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1912549676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 N RAVENSWOOD AVE STE 225",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405802",
            "telephone_number": "312-667-3775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 N RAVENSWOOD AVE STE 225",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405802",
            "telephone_number": "312-667-3775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND CHICAGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-15",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "MEYERSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "312-667-3775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; 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.