| Blue Moon Senior Counseling Of California Llc | |
|
10204 Bode St Ste B Plainfield IL 60585-9813 | |
| (855) 241-7160 | |
| (954) 324-8354 |
| Full Name | Blue Moon Senior Counseling Of California Llc |
|---|---|
| Speciality | Social Worker |
| Location | 10204 Bode St Ste B, Plainfield, Illinois |
| Authorized Official Name and Position | Melanie E Donohue (OWNER) |
| Authorized Official Contact | 8552417160 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Moon Senior Counseling Of California Llc 10204 Bode St Ste B Plainfield IL 60585-9813 Ph: (855) 241-7160 | Blue Moon Senior Counseling Of California Llc 10204 Bode St Ste B Plainfield IL 60585-9813 Ph: (855) 241-7160 |
| NPI Number | 1447678990 |
|---|---|
| Provider Enumeration Date | 04/02/2014 |
| Last Update Date | 09/20/2019 |
| Medicare PECOS PAC ID | 9335360981 |
|---|---|
| Medicare Enrollment ID | O20141023000497 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447678990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW8327 (Florida) | Primary |
| Provider Name | Bruce Rays |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053598300 PECOS PAC ID: 3476501750 Enrollment ID: I20050104000772 |
| Provider Name | Edmund Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497836670 PECOS PAC ID: 2769492917 Enrollment ID: I20060502000693 |
| Provider Name | Bonnie W Meyerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538297338 PECOS PAC ID: 2567526809 Enrollment ID: I20090130000438 |
| Provider Name | Lillian Machin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902090533 PECOS PAC ID: 7416014147 Enrollment ID: I20090325000437 |
| Provider Name | Corinne Swaner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922284769 PECOS PAC ID: 3779776331 Enrollment ID: I20101015000374 |
| Provider Name | Eleanore M Baidoo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255459939 PECOS PAC ID: 4486811387 Enrollment ID: I20120203000697 |
| Provider Name | Carmit Zur |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013283753 PECOS PAC ID: 0749443745 Enrollment ID: I20120530000684 |
| Provider Name | Kim C Bierwolf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881728574 PECOS PAC ID: 2769647304 Enrollment ID: I20120703000552 |
| Provider Name | Hilda Balakhane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548579402 PECOS PAC ID: 8729200803 Enrollment ID: I20141104002578 |
| Provider Name | Edward Lei |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538536230 PECOS PAC ID: 1052628286 Enrollment ID: I20150921000316 |
| Provider Name | Kiana Kalaghichian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023381761 PECOS PAC ID: 3375848377 Enrollment ID: I20160301000791 |
| Provider Name | Elizabeth Allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588962617 PECOS PAC ID: 4789981747 Enrollment ID: I20160318001317 |
| Provider Name | Jennifer Nicole Rugala Persicone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205104551 PECOS PAC ID: 3779861299 Enrollment ID: I20161103000130 |
| Provider Name | Julia Spruell Jeffery |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275605529 PECOS PAC ID: 6002919560 Enrollment ID: I20161130000575 |
| Provider Name | Kathryn A Jacobs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063963072 PECOS PAC ID: 6305126061 Enrollment ID: I20161215000469 |
| Provider Name | Patricia Beth Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720231392 PECOS PAC ID: 1456631118 Enrollment ID: I20161215000609 |
| Provider Name | Sharon J Lucas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679833230 PECOS PAC ID: 0547546475 Enrollment ID: I20170407001388 |
| Provider Name | Dana A Walker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518038785 PECOS PAC ID: 1052698396 Enrollment ID: I20170515001734 |
| Provider Name | Sonja Zonee Carter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255476362 PECOS PAC ID: 4981976255 Enrollment ID: I20170821003477 |
| Provider Name | Cheryl Osman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427378231 PECOS PAC ID: 4082975933 Enrollment ID: I20180309001891 |
| Provider Name | Paul Goshgarian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861521205 PECOS PAC ID: 9931454139 Enrollment ID: I20180612000622 |
| Provider Name | Jenica Polakow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225529159 PECOS PAC ID: 0143577502 Enrollment ID: I20180717002979 |
| Provider Name | Anqoinette Crowder-jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922370311 PECOS PAC ID: 6103170980 Enrollment ID: I20181114000683 |
| Provider Name | Maurice J Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205142262 PECOS PAC ID: 4789938234 Enrollment ID: I20181119003252 |
| Provider Name | Cynthia Lowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639658636 PECOS PAC ID: 5890039580 Enrollment ID: I20181206002712 |
| Provider Name | Cindy Hyatt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821042490 PECOS PAC ID: 5294746640 Enrollment ID: I20190204002513 |
| Provider Name | Hila Raen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124251723 PECOS PAC ID: 1254679160 Enrollment ID: I20190218002616 |
| Provider Name | Patricia De La Torre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306966122 PECOS PAC ID: 1850631854 Enrollment ID: I20190328001079 |
| Provider Name | Julio Garibay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073921300 PECOS PAC ID: 2264767110 Enrollment ID: I20190715001338 |
| Provider Name | Corey Nash |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891087128 PECOS PAC ID: 5890021018 Enrollment ID: I20190725003117 |
| Provider Name | Joanne Levine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285106252 PECOS PAC ID: 6103154794 Enrollment ID: I20190820003889 |
| Provider Name | Jamie Trachtenberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528198231 PECOS PAC ID: 1355671041 Enrollment ID: I20190923002732 |
| Provider Name | Charity Lazzari |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801045349 PECOS PAC ID: 7113359225 Enrollment ID: I20191111002736 |
| Provider Name | Yvette Wade |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740577881 PECOS PAC ID: 2163855370 Enrollment ID: I20191202001773 |
| Provider Name | Yajaira Kennison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700031648 PECOS PAC ID: 8820421316 Enrollment ID: I20191216000744 |
| Provider Name | Tiffanie Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083015572 PECOS PAC ID: 6709211048 Enrollment ID: I20200115001676 |
| Provider Name | Veronica Baron-vartian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457683633 PECOS PAC ID: 2860827847 Enrollment ID: I20200122000326 |
| Provider Name | Stacey Garfinkel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932739356 PECOS PAC ID: 3274960489 Enrollment ID: I20200228001307 |
| Provider Name | Nancy Coxwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477892719 PECOS PAC ID: 0749618189 Enrollment ID: I20200317002073 |
| Provider Name | Hyehyun J Park |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679097166 PECOS PAC ID: 3274957741 Enrollment ID: I20200717000588 |
| Provider Name | Andrea Nadine Santana |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184959116 PECOS PAC ID: 2466878855 Enrollment ID: I20200817000520 |
| Provider Name | Anne Therese Chicoine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447366752 PECOS PAC ID: 7810317013 Enrollment ID: I20201008001670 |
| Provider Name | Darlene Jeris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801202221 PECOS PAC ID: 6800216326 Enrollment ID: I20201021001392 |
| Provider Name | Jhoana Sarabia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891102349 PECOS PAC ID: 2961822333 Enrollment ID: I20201023002169 |
| Provider Name | Jacqueline Sara Mollitor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457542441 PECOS PAC ID: 5496175721 Enrollment ID: I20201026001872 |
| Provider Name | Vimmi Jaggi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801107602 PECOS PAC ID: 2365862612 Enrollment ID: I20201026002678 |
| Provider Name | Leah M Kramer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225344088 PECOS PAC ID: 0941497101 Enrollment ID: I20201102002134 |
| Provider Name | Raizel Chaya Lax |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588006134 PECOS PAC ID: 2668884909 Enrollment ID: I20201210001812 |
| Provider Name | Edith J. Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366824708 PECOS PAC ID: 9537574215 Enrollment ID: I20210211001948 |
| Provider Name | Dorene M Fanning |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831523711 PECOS PAC ID: 0345663274 Enrollment ID: I20210312001825 |
| Provider Name | Ying Moua |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053923300 PECOS PAC ID: 9830516699 Enrollment ID: I20210330002144 |
| Provider Name | Joyce Mayne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396243705 PECOS PAC ID: 4486062924 Enrollment ID: I20210421001592 |
| Provider Name | Elliott Alcala |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295241438 PECOS PAC ID: 2961811922 Enrollment ID: I20210504002931 |
| Provider Name | Spring Peabody |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699396713 PECOS PAC ID: 1850700626 Enrollment ID: I20210506002479 |
| Provider Name | Maria Salome Garde |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326562083 PECOS PAC ID: 4486053790 Enrollment ID: I20210518002723 |
| Provider Name | Redd Edeejahnai Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629418710 PECOS PAC ID: 7416358692 Enrollment ID: I20210624003436 |
| Provider Name | Kathleen Hagerty Pestrella |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326643404 PECOS PAC ID: 8729489877 Enrollment ID: I20210625002266 |
| Provider Name | Candace R Kerwin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407154362 PECOS PAC ID: 3577964436 Enrollment ID: I20210629002790 |
| Provider Name | Darren Kong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447685078 PECOS PAC ID: 5597169441 Enrollment ID: I20210813002883 |
| Provider Name | Melissa A Swenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821361205 PECOS PAC ID: 2062817976 Enrollment ID: I20210816001850 |
| Provider Name | Karin Barragato |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538835228 PECOS PAC ID: 1153729967 Enrollment ID: I20211008001536 |
| Provider Name | Nikki Barrett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346856697 PECOS PAC ID: 2567850027 Enrollment ID: I20211102002682 |
| Provider Name | Elliana Ixta Madera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922432319 PECOS PAC ID: 4688063431 Enrollment ID: I20211116002393 |
| Provider Name | Joanna S Dunton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841758711 PECOS PAC ID: 5991194508 Enrollment ID: I20211118002922 |
| Provider Name | Darci Elise Simms |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053740001 PECOS PAC ID: 0648697920 Enrollment ID: I20220224002245 |
| Provider Name | Rosemary Lynn Nielsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649755380 PECOS PAC ID: 1658765094 Enrollment ID: I20220228002165 |
| Provider Name | Kamla Fennimore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710274519 PECOS PAC ID: 2163651019 Enrollment ID: I20220317000561 |
| Provider Name | Katerina Leyzerovich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174129647 PECOS PAC ID: 9638556293 Enrollment ID: I20220519002473 |
| Provider Name | Robert James Porta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962550327 PECOS PAC ID: 3274910625 Enrollment ID: I20220524002474 |
| Provider Name | Carol Ruth Childers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396993275 PECOS PAC ID: 3476748898 Enrollment ID: I20220629002779 |
| Provider Name | Jennifer Ayala |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831679893 PECOS PAC ID: 4082094305 Enrollment ID: I20220705001676 |
| Provider Name | Liset Salcedo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215330170 PECOS PAC ID: 0749661981 Enrollment ID: I20220719001321 |
| Provider Name | Katherine Ann Lundell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578201893 PECOS PAC ID: 6709269095 Enrollment ID: I20220819000261 |
| Provider Name | Yvonne Mendoza |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689962896 PECOS PAC ID: 2567845662 Enrollment ID: I20220823002576 |
| Provider Name | Deborah Lee Hunt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730206087 PECOS PAC ID: 5496139610 Enrollment ID: I20220907000702 |
| Provider Name | Dalia Rubi Merida Cuevas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205260908 PECOS PAC ID: 4082099452 Enrollment ID: I20220921001734 |
| Provider Name | Mary Catherine Proffitt-allison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780763797 PECOS PAC ID: 7719354554 Enrollment ID: I20221107003138 |
| Provider Name | Sheila Zwirn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871939785 PECOS PAC ID: 0749658052 Enrollment ID: I20221117001210 |
| Provider Name | Jennifer Nicole Ray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811379506 PECOS PAC ID: 5597133785 Enrollment ID: I20221118001876 |
| Provider Name | Molly Beth Schwarzmueller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821668526 PECOS PAC ID: 1355710310 Enrollment ID: I20221213003379 |
| Provider Name | Laura Levin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053859470 PECOS PAC ID: 1557730421 Enrollment ID: I20221215001982 |
| Provider Name | Kimberly Alene Rudy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205150760 PECOS PAC ID: 3173993763 Enrollment ID: I20221222001134 |
| Provider Name | Elizabeth Bloombaum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316178890 PECOS PAC ID: 8820460587 Enrollment ID: I20230207002447 |
| Provider Name | Shahrezad Chiha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194260083 PECOS PAC ID: 7517366776 Enrollment ID: I20230313002231 |
| Provider Name | Jodi R Klubnik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952776684 PECOS PAC ID: 8628447687 Enrollment ID: I20230511003463 |
| Provider Name | Wendi Jessica Avila |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982188900 PECOS PAC ID: 6608233523 Enrollment ID: I20230608001983 |
| Provider Name | Sheela Mandava |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356816185 PECOS PAC ID: 8921465840 Enrollment ID: I20230608002180 |
| Provider Name | Maureen Rosa Salinas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073245577 PECOS PAC ID: 8628435427 Enrollment ID: I20230609002575 |
| Provider Name | Sarah Rice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700010634 PECOS PAC ID: 0143686311 Enrollment ID: I20230718001996 |
| Provider Name | Hannah Bernard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699410449 PECOS PAC ID: 0345600615 Enrollment ID: I20230718002772 |
| Provider Name | Anna L Barrios |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639160625 PECOS PAC ID: 7113172529 Enrollment ID: I20231122000341 |
| Provider Name | Cynthia Talmich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376013227 PECOS PAC ID: 9234589532 Enrollment ID: I20231228003405 |
| Provider Name | Anya Kaufman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083978449 PECOS PAC ID: 9537511480 Enrollment ID: I20240117000900 |
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