Brenda Black LCSW PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149013929 Issued in IL

Legal business name

BRENDA BLACK LCSW PC

Practice address

717 Main St
Suite 2E
Evanston, IL 60202-1701

Phone

(312) 718-6996

NPI assigned

Jun 30, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Brenda N Black, LCSW PCNPI 1245554724

Title

Owner

Phone

(312) 718-6996

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brenda N Black, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1245554724
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308787200000",
    "number": "1265743637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 MAIN ST",
            "address_2": "SUITE 2E",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021701",
            "telephone_number": "312-718-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 MAIN ST",
            "address_2": "SUITE 2E",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021701",
            "telephone_number": "312-718-6996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENDA BLACK LCSW PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-30",
        "last_updated": "2011-06-23",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-718-6996",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW PC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikolas Brcic
• Yosvani Breal
• Abigail Adele Breeze, M.D.
• Joanne C Bregman, PHD
• Anthony L Breitbach, D.C.
• Charles B. Brendler, MD
• Stephanie Brenner, LCSW
• Evora Juanita Brent, MD
• Douglas Carl Breunlin, LCSW
• Breving Physical Therapy PLLC

• Clinical Social Worker in Evanston, IL
• Providers in Evanston, 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 Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.