Individual provider Active NPI

Shaysa Esther Villa, LCSW

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1417511890
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149021207 Issued in IL
Practice address
47 W Polk St Ste 325
Chicago, IL 60605-2175
Phone
(312) 667-3884
NPI assigned
Apr 30, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149021207 IL Primary

Addresses

Primary practice location

47 W Polk St Ste 325
Chicago, IL 60605-2175

Mailing address

1136 S Delano CT W Ste B201
Chicago, IL 60605-3734
Phone (312) 667-3884

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

State licenses

LicenseStateTypeSpecialty
149021207ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Roamers Therapy LLC Clinical CurrentSince May 18, 2025 Accepting new patients

Locations

1136 S Delano Ct W
Ste B201
Chicago, IL 60605
Phone (312) 248-0230

47 W Polk St
Ste 325
Chicago, IL 60605
Phone (312) 667-3884

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1417511890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 S DELANO CT W STE B201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053734",
            "telephone_number": "312-667-3884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 W POLK ST STE 325",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052175",
            "telephone_number": "312-667-3884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLA",
        "first_name": "SHAYSA",
        "middle_name": "ESTHER",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-30",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149021207",
            "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 May 14, 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.