MEDICARE: ONE FAMILY ILLINOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	253J00000X	Foster Care Agency	198705	IL

General Provider Information

NPI Number	:	1932598893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE FAMILY ILLINOIS

Provider Business Mailing Address
First Line	:	216 W JACKSON BLVD STE 925
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-6996
Country	:	US
Telephone Number	:	312-372-8200
Fax Number	:	312-372-8202

Provider Business Practice Location Address
First Line	:	1133 W 13TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1881
Country	:	US
Telephone Number	:	312-243-1901
Fax Number	:	312-243-3086

Authorized Official
Title or Position	:	DIRECTOR OF BEHAVIORAL HEALTH
Name	:	GLORIA MARIN COCKERILL
Credential	:	LCSW
Telephone Number	:	312-243-1901

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	10/05/2025

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Directions to “ONE FAMILY ILLINOIS ” Practice Location

Language	Start Address	Practice Location

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