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PROJECT VIDA INC. NPI 1285167577


NPI Information

NPI: 1285167577
Provider Name: PROJECT VIDA, INC.
Classification: Social Worker - 1041C0700X
Entity Type: Organization

Specialization: Clinical

CLIA Number: 14D1023970

Address:
2659 S KEDVALE AVE
CHICAGO, IL
ZIP 60623
Phone: (773) 277-2291
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PROJECT VIDA, INC. is a clinical social worker in Chicago, IL. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. PROJECT VIDA, INC. NPI is 1285167577. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2659 S KEDVALE AVE
CHICAGO, IL
ZIP 60623-322
Phone: (773) 277-2291

The provider's authorized official is Jerome Montgomery .
The authorized official title is Executive Director and has the following contact phone number (773) 277-2291.

The CLIA number assigned to this NPI record is 14D1023970 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/4/2017 and was last updated on 4/4/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101Y00000XCounselorNo
2101YA0400XCounselorAddiction (Substance Use Disorder)No
3101YM0800XCounselorMental HealthNo
4103TA0400XPsychologistAddiction (Substance Use Disorder)No
5104100000XSocial WorkerNo
61041C0700XSocial WorkerClinicalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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