Active NPI
Joanna Kate Lackaye, LCSW
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1497043764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.015939
- Practice address
- 2736 N Southport Ave # 1
Chicago, IL 60614 - Phone
- (573) 356-7909
- NPI assigned
- Jul 20, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150012886 | IL | |
| Clinical Social Worker | 1041C0700X | 149.015939 | IL | Primary |
Addresses
Primary practice location
2736 N Southport Ave # 1
Chicago, IL 60614
Mailing address
2736 N Southport Ave # 1
Chicago, IL 60614-1230
Phone (573) 356-7909
Other practice location 1
4740 N Clark St
Chicago, IL 60640-4689
Phone (773) 769-0205
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1616824 | Other | IL | BLUE SHIELD |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 150012886 | IL | MD | Social Worker |
| 149.015939 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lackaye Therapy and Advocacy LLC | Clinical | Past | Accepting new patients |
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": "1311120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548892800000",
"number": "1497043764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2736 N SOUTHPORT AVE # 1",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606141230",
"telephone_number": "573-356-7909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2736 N SOUTHPORT AVE # 1",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60614",
"telephone_number": "573-356-7909"
}
],
"practiceLocations": [
{
"address_1": "4740 N Clark St",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606404689",
"country_code": "US",
"telephone_number": "773-769-0205",
"fax_number": "773-765-0842",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LACKAYE",
"first_name": "JOANNA",
"middle_name": "KATE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-20",
"last_updated": "2019-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150012886",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.015939",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "1616824",
"state": "IL"
}
],
"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 Jan 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.