| Livindi Medical Group Illinois Pllc | |
|
1328 Main St Crete IL 60417-2131 | |
| (508) 416-6026 | |
| Not Available |
| Full Name | Livindi Medical Group Illinois Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1328 Main St, Crete, Illinois |
| Authorized Official Name and Position | Richard M Watkins (ADMINISTRATOR) |
| Authorized Official Contact | 5084166026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Livindi Medical Group Illinois Pllc Po Box 70 Wayland MA 01778-0070 Ph: (508) 416-6026 | Livindi Medical Group Illinois Pllc 1328 Main St Crete IL 60417-2131 Ph: (508) 416-6026 |
| NPI Number | 1457038994 |
|---|---|
| Provider Enumeration Date | 06/28/2023 |
| Last Update Date | 07/24/2023 |
| Certification Date | 07/24/2023 |
| Medicare PECOS PAC ID | 5092178616 |
|---|---|
| Medicare Enrollment ID | O20230830002290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457038994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Aldo Hernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871772384 PECOS PAC ID: 3870563299 Enrollment ID: I20080128000351 |
| Provider Name | Mark Norbert Guiab |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346770914 PECOS PAC ID: 7113284142 Enrollment ID: I20171130000210 |
| Provider Name | Christine Wanyana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356624035 PECOS PAC ID: 3678832656 Enrollment ID: I20180119001530 |
| Provider Name | Asia Craig |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104699305 PECOS PAC ID: 3971954751 Enrollment ID: I20240105000921 |
| Provider Name | Rosalynn Grissett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902927098 PECOS PAC ID: 4981055779 Enrollment ID: I20240105001343 |
| Provider Name | Allison Beverly Oliver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073106399 PECOS PAC ID: 8123479961 Enrollment ID: I20240105003036 |
| Provider Name | Monika Pszczola |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922875244 PECOS PAC ID: 4082067111 Enrollment ID: I20240125000955 |
| Provider Name | Helen Seretis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336918945 PECOS PAC ID: 3779926431 Enrollment ID: I20240209000541 |
| Provider Name | Yekaterina Shcherbakova |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609418607 PECOS PAC ID: 1153766530 Enrollment ID: I20240226000145 |
| Provider Name | Helen Seretis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336918945 PECOS PAC ID: 3779926431 Enrollment ID: I20240226000198 |
| Provider Name | Robert Dennis Jaskula |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073859948 PECOS PAC ID: 5294172821 Enrollment ID: I20240319001593 |
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