Individual provider Active NPI

Brandon Lavell Barksdale

  • Social Worker
  • Chicago, IL
National Provider Identifier
1053107771
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
415 S Kilpatrick Ave
Chicago, IL 60644-4923
Phone
(773) 854-1511
NPI assigned
Apr 18, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X Primary

Addresses

Primary practice location

415 S Kilpatrick Ave
Chicago, IL 60644-4923

Mailing address

1645 W Jarvis Ave Apt 1E
Chicago, IL 60626-7061
Phone (224) 247-1746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1053107771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W JARVIS AVE APT 1E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606267061",
            "telephone_number": "224-247-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S KILPATRICK AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606444923",
            "telephone_number": "773-854-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARKSDALE",
        "first_name": "BRANDON",
        "middle_name": "LAVELL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-18",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.