Active NPI
Mary Susan Tate, L.C.S.W.
- Clinical Social Worker
- Kankakee, IL
National Provider Identifier
1952693327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149004851
- Practice address
- 1905 W Court St
Kankakee, IL 60901-3163 - Phone
- (815) 933-2240
- Fax
- (815) 936-8659
- NPI assigned
- May 4, 2011
- 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 Social Worker | 1041C0700X | 149004851 | IL | Primary |
Addresses
Primary practice location
1905 W Court St
Kankakee, IL 60901-3163
Mailing address
1905 W Court St
Kankakee, IL 60901-3163
Phone (815) 933-2240
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304467200000",
"number": "1952693327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1905 W COURT ST",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609013163",
"telephone_number": "815-933-2240",
"fax_number": "815-936-8659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1905 W COURT ST",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609013163",
"telephone_number": "815-933-2240",
"fax_number": "815-936-8659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATE",
"first_name": "MARY",
"middle_name": "SUSAN",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-04",
"last_updated": "2011-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149004851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.