Brenda N Black, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149013929 Issued in IL

Practice address

1316 W Erie St
Chicago, IL 60642-5718

Phone

(312) 718-6996

Fax

(872) 813-5242

NPI assigned

Mar 26, 2010

Last updated

Oct 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brenda Black LCSW PC

  • Clinical Social Worker
  • Evanston, IL
  • NPI 1265743637
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667088000000",
    "number": "1245554724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4256 N RAVENSWOOD AVE",
            "address_2": "SUITE 315",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131110",
            "telephone_number": "312-718-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 W ERIE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606425718",
            "telephone_number": "312-718-6996",
            "fax_number": "872-813-5242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "717 Main St",
            "address_2": "suite 2E",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602021701",
            "country_code": "US",
            "telephone_number": "312-718-6996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "BRENDA",
        "middle_name": "N",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-26",
        "last_updated": "2022-10-30",
        "certification_date": "2022-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Black-Jordan
• Adam Black, MD
• Amy Louise Black, DT
• Ashley Black, APN
• Beverly Black
• Elizabeth Black
• Grace Elizabeth Black
• Jacques D Black, LSW
• Jessica L Black, LCPC
• Jhada Black

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.