Latavia Shantaye Agada, MA, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.018494 Issued in IL

Practice address

2823 Glenwood Ave.
Rockford, IL 61101

Phone

(815) 968-5342

Fax

(815) 968-4656

NPI assigned

Jun 12, 2015

Last updated

Feb 18, 2025By 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 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: patrick.albert.p16@direct.fhn-fqhc.nextgenshare.com

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.

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  • Clinical Social Worker
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• Glenwood Center LTD

  • Psychiatry Physician
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  • NPI 1003033861
  NPD (past)

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

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1417338799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2823 GLENWOOD AVENUE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61101",
            "telephone_number": "815-968-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 GLENWOOD AVE.",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61101",
            "telephone_number": "815-968-5342",
            "fax_number": "815-968-4656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8280 Willow Oaks Corporate Dr Ste 600",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314516",
            "country_code": "US",
            "telephone_number": "415-424-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "475 Biltmore Way Ste 109",
            "address_purpose": "LOCATION",
            "city": "Coral Gables",
            "state": "FL",
            "postal_code": "331345724",
            "country_code": "US",
            "telephone_number": "415-424-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8300 Esters Blvd Ste 900",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750632233",
            "country_code": "US",
            "telephone_number": "415-424-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 W Jackson Blvd Downtown",
            "address_2": "Suite 1700",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60604",
            "country_code": "US",
            "telephone_number": "415-424-4266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGADA",
        "first_name": "LATAVIA",
        "middle_name": "SHANTAYE",
        "credential": "MA, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-12",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150015210",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.018494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Affiliated Surgeons of Rockford LLC
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• Affordable Dentures - Rock Hill, P.C.
• Hany M Afram, MD
• Mohammed S Afzal, M.D.
• Jennifer Edugwu Agbo
• Carlos Aguero-Medina, MD
• Isabella Marie Aguirre, PA-C
• Ann Agustsson Mathers, D.O.
• Thordur Skuli Agustsson, MD

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, 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 Feb 18, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.