Active NPI
Stephany M Brutsman, LCSW
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1942822002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.021860
- Practice address
- 4840 W Byron St
Chicago, IL 60641-2778 - Phone
- (773) 319-0238
- Fax
- (773) 282-7800
- NPI assigned
- May 12, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.021860 | IL | Primary |
Addresses
Primary practice location
4840 W Byron St
Chicago, IL 60641-2778
Mailing address
1001 E Touhy Ave Ste 50
Des Plaines, IL 60018-5817
Phone (773) 319-0238
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149.021860 | Other | IL | LCSW LICENSING NUMBER |
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 |
|---|---|---|---|
| 149.021860 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589241600000",
"number": "1942822002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 E TOUHY AVE STE 50",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600185817",
"telephone_number": "773-319-0238",
"fax_number": "773-282-7800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4840 W BYRON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606412778",
"telephone_number": "773-319-0238",
"fax_number": "773-282-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUTSMAN",
"first_name": "STEPHANY",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-12",
"last_updated": "2020-05-12",
"certification_date": "2020-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.021860",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW LICENSING NUMBER",
"identifier": "149.021860",
"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 May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.