Keith J. Harris, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149018572 Issued in IL

Practice address

3411 W Diversey Ave Ofc 14
Chicago, IL 60647-1245

Phone

(224) 534-0331

NPI assigned

Feb 22, 2018

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Resilience Rising, PLLC

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1124787379
  NPD Authorized official

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1508367848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3411 W DIVERSEY AVE OFC 14",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471245",
            "telephone_number": "224-534-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 W DIVERSEY AVE OFC 14",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471245",
            "telephone_number": "224-534-0331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4648 N Leclaire Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606303817",
            "country_code": "US",
            "telephone_number": "773-454-3059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "KEITH",
        "middle_name": "J.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-22",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149018572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John P Harris, LCSW
• Julie Anne Harris
• Kallyn Harris, OTR/L, CSRS
• Katie Harris, PA-C
• Kayla Harris, LMFT
• Kevin Harris
• Kevin Harris
• Kurt Harris
• Ladonna Harris
• Lakeitta Harris

• 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 Jan 4, 2021; 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.