| Blue Moon Senior Counseling | |
|
10204 Bode St Ste B Plainfield IL 60585-9813 | |
| (855) 241-7160 | |
| (954) 324-8354 |
| Full Name | Blue Moon Senior Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 10204 Bode St Ste B, Plainfield, Illinois |
| Authorized Official Name and Position | Melanie Donohue (OWNER) |
| Authorized Official Contact | 7024030438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Moon Senior Counseling 10204 Bode St Ste B Plainfield IL 60585-9813 Ph: (855) 241-7160 | Blue Moon Senior Counseling 10204 Bode St Ste B Plainfield IL 60585-9813 Ph: (855) 241-7160 |
| NPI Number | 1205129186 |
|---|---|
| Provider Enumeration Date | 05/25/2011 |
| Last Update Date | 05/18/2021 |
| Certification Date | 05/18/2021 |
| Medicare PECOS PAC ID | 6103099759 |
|---|---|
| Medicare Enrollment ID | O20111027000391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205129186 | NPI | - | NPPES |
| FL606A | Other | FL | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW8327 (Florida) | Primary |
| Provider Name | Herenia Ferreiro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457458242 PECOS PAC ID: 2961301890 Enrollment ID: I20040108000644 |
| Provider Name | Maria Schick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952522385 PECOS PAC ID: 5991774358 Enrollment ID: I20041001000374 |
| Provider Name | Sandra B Teuber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174786446 PECOS PAC ID: 4284670373 Enrollment ID: I20050629000287 |
| Provider Name | Melanie Donohue |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477613750 PECOS PAC ID: 0547362196 Enrollment ID: I20070228000155 |
| Provider Name | Bruce W Harms |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346202959 PECOS PAC ID: 5395821961 Enrollment ID: I20080324000110 |
| Provider Name | Alethea Kluver-williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881877330 PECOS PAC ID: 6709962228 Enrollment ID: I20080408000537 |
| Provider Name | Svetlana S Sokol |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639361587 PECOS PAC ID: 4284795733 Enrollment ID: I20081203000254 |
| Provider Name | Emily A Flowers-yahn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659522944 PECOS PAC ID: 1557498730 Enrollment ID: I20100420000358 |
| Provider Name | Sara J Hewitt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649383928 PECOS PAC ID: 8224210661 Enrollment ID: I20110307000794 |
| Provider Name | Marcie Mcmaster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174897052 PECOS PAC ID: 2062679343 Enrollment ID: I20120130000633 |
| Provider Name | Margrit H Goodhand |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902128879 PECOS PAC ID: 4284893116 Enrollment ID: I20120312000719 |
| Provider Name | Janis Blenden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477808145 PECOS PAC ID: 6608009139 Enrollment ID: I20140507000787 |
| Provider Name | David J Pirola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952641250 PECOS PAC ID: 4981829728 Enrollment ID: I20140710001261 |
| Provider Name | Karen E Loomis Robb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336545292 PECOS PAC ID: 3375866965 Enrollment ID: I20150107001189 |
| Provider Name | Jennifer Betancur |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164815023 PECOS PAC ID: 7618295635 Enrollment ID: I20150422002147 |
| Provider Name | Jennifer Schaefer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770997512 PECOS PAC ID: 5890009278 Enrollment ID: I20150729008036 |
| Provider Name | Virginia A Meinke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396132262 PECOS PAC ID: 5193030005 Enrollment ID: I20150820010839 |
| Provider Name | Debra Diane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861757239 PECOS PAC ID: 8820376379 Enrollment ID: I20161103001071 |
| Provider Name | Stephanie Cunningham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457494270 PECOS PAC ID: 4486934502 Enrollment ID: I20161207001694 |
| Provider Name | Hector Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487974796 PECOS PAC ID: 9234423179 Enrollment ID: I20161207002042 |
| Provider Name | Dhaima Chin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407392111 PECOS PAC ID: 7113201708 Enrollment ID: I20170227001698 |
| Provider Name | Cynthia Shinaberry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821522996 PECOS PAC ID: 4880962588 Enrollment ID: I20170621002858 |
| Provider Name | Francesca Harmon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023084498 PECOS PAC ID: 6608146295 Enrollment ID: I20170713002766 |
| Provider Name | Beatriz M Morales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922185883 PECOS PAC ID: 7315219854 Enrollment ID: I20170818000669 |
| Provider Name | Gretchen Natale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316340326 PECOS PAC ID: 6800161241 Enrollment ID: I20171010003557 |
| Provider Name | Cynthia Schwartz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275045296 PECOS PAC ID: 0345508354 Enrollment ID: I20171221000843 |
| Provider Name | Patricia Demasky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528361953 PECOS PAC ID: 5698034692 Enrollment ID: I20180119002678 |
| Provider Name | Julia A Talmadge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629270566 PECOS PAC ID: 3971863432 Enrollment ID: I20180201002615 |
| Provider Name | Kerry Ann Brown-faison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891143970 PECOS PAC ID: 4284994161 Enrollment ID: I20180214002565 |
| Provider Name | Nancy Shaffer Klein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235502022 PECOS PAC ID: 9436450848 Enrollment ID: I20180228001886 |
| Provider Name | Jennifer L Bloom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467966606 PECOS PAC ID: 9931464229 Enrollment ID: I20180608000236 |
| Provider Name | Renee Tong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811494347 PECOS PAC ID: 7911259759 Enrollment ID: I20181005002691 |
| Provider Name | Meta Petty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801377189 PECOS PAC ID: 1658615018 Enrollment ID: I20181212000733 |
| Provider Name | Lisa Sarkees |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669948261 PECOS PAC ID: 8628313244 Enrollment ID: I20181228001793 |
| Provider Name | Jaelah Enoc Mendez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952889974 PECOS PAC ID: 4880932540 Enrollment ID: I20190205003127 |
| Provider Name | Laura Ciampa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184091001 PECOS PAC ID: 0446560726 Enrollment ID: I20190325001689 |
| Provider Name | Edn Habte |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407306780 PECOS PAC ID: 9436482650 Enrollment ID: I20190603002496 |
| Provider Name | Kristina Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750505459 PECOS PAC ID: 8022341031 Enrollment ID: I20190606000988 |
| Provider Name | Larisa Correa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760811376 PECOS PAC ID: 5496098469 Enrollment ID: I20190612000783 |
| Provider Name | Andrea Betting |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881068922 PECOS PAC ID: 0840526802 Enrollment ID: I20190729002523 |
| Provider Name | Priya Narine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720540719 PECOS PAC ID: 0648507293 Enrollment ID: I20190806001403 |
| Provider Name | Shanique Ebanks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578937918 PECOS PAC ID: 3870820798 Enrollment ID: I20190814002991 |
| Provider Name | Jane Cruz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396133831 PECOS PAC ID: 2668700386 Enrollment ID: I20190820000509 |
| Provider Name | Cruz Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780980144 PECOS PAC ID: 4688903370 Enrollment ID: I20190905001235 |
| Provider Name | Gloria Monasmith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770832859 PECOS PAC ID: 5991037129 Enrollment ID: I20191021002954 |
| Provider Name | Kristina Sepe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669016911 PECOS PAC ID: 2961835541 Enrollment ID: I20191212001652 |
| Provider Name | Donald Cook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801439500 PECOS PAC ID: 1153754759 Enrollment ID: I20191212002546 |
| Provider Name | Nancy Pena |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770887838 PECOS PAC ID: 2961759030 Enrollment ID: I20200204001929 |
| Provider Name | Dorothy Lynette Milton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952808263 PECOS PAC ID: 4284056599 Enrollment ID: I20200615001667 |
| Provider Name | Arnold Gene Hopkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104038975 PECOS PAC ID: 6901229756 Enrollment ID: I20200713000616 |
| Provider Name | Racquel Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326661315 PECOS PAC ID: 3678998366 Enrollment ID: I20200728003221 |
| Provider Name | Sunny Philip |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487021721 PECOS PAC ID: 5193143378 Enrollment ID: I20200921001757 |
| Provider Name | Nora Beth Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134746530 PECOS PAC ID: 2961822598 Enrollment ID: I20201020000816 |
| Provider Name | Katrina Forman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447538269 PECOS PAC ID: 1658785233 Enrollment ID: I20210121001896 |
| Provider Name | Yousuf Sayeed |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1932155926 PECOS PAC ID: 6901889823 Enrollment ID: I20210122001130 |
| Provider Name | Cashauna Tuggle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801304084 PECOS PAC ID: 2860806742 Enrollment ID: I20210204002429 |
| Provider Name | Bianke Gadsden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780274480 PECOS PAC ID: 3577978329 Enrollment ID: I20210209001628 |
| Provider Name | Nadia Zahara Jomaa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154936482 PECOS PAC ID: 3577978220 Enrollment ID: I20210210003318 |
| Provider Name | Alisa R Mcgee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851981666 PECOS PAC ID: 8527476639 Enrollment ID: I20210408002494 |
| Provider Name | Sheryl Lerner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508418187 PECOS PAC ID: 8820994114 Enrollment ID: I20210719001510 |
| Provider Name | Benjamin L Tidwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861407520 PECOS PAC ID: 1355441940 Enrollment ID: I20210910001798 |
| Provider Name | Sharon A Buttermore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912266198 PECOS PAC ID: 4880833227 Enrollment ID: I20211008001291 |
| Provider Name | Maria Pedreguera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215608880 PECOS PAC ID: 1658763321 Enrollment ID: I20220110002330 |
| Provider Name | Mary A Clark Webster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720636160 PECOS PAC ID: 3274926191 Enrollment ID: I20221130003104 |
| Provider Name | Leslie Sikaffy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831716687 PECOS PAC ID: 1951798644 Enrollment ID: I20221208001841 |
| Provider Name | Robert Gary Rosenthal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831769959 PECOS PAC ID: 1557765401 Enrollment ID: I20230110003250 |
| Provider Name | Debra Evonne Thrower |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912366956 PECOS PAC ID: 8527424415 Enrollment ID: I20230518003050 |
| Provider Name | Mary F Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932368420 PECOS PAC ID: 9133586464 Enrollment ID: I20230601000974 |
| Provider Name | Gail S. Maurer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154553238 PECOS PAC ID: 2264773134 Enrollment ID: I20230818000174 |
| Provider Name | Karen Vigeland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841938867 PECOS PAC ID: 9436504263 Enrollment ID: I20231013000217 |
| Provider Name | Joy F Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376282087 PECOS PAC ID: 6002279247 Enrollment ID: I20231111000618 |
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