Amy Kristin Black, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.022647 Issued in IL

Practice address

5000 S 5TH Ave
Hines, IL 60141-3030

Phone

(708) 202-7816

NPI assigned

Nov 1, 2021

Last updated

Nov 1, 2021By the provider in NPPES

Sex

Female

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

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

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1952066441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3342 N OAKLEY AVE APT 3N",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186235",
            "telephone_number": "312-231-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 S 5TH AVE",
            "city": "HINES",
            "state": "IL",
            "postal_code": "601413030",
            "telephone_number": "708-202-7816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "AMY",
        "middle_name": "KRISTIN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-01",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.022647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ulyana Bilyk, LPN
• Justin Leith Birnholz, PHD
• Mariann Blacconiere, LCSW
• Michael J Blacconiere, PH.D.
• Alan D Black
• Jennifer Ann Blake, LSW
• China Blakemore
• Kristan Blum
• Dawn Bolton, PHARMD
• Katherine Bonev

• Clinical Social Worker in Hines, IL
• Providers in Hines, 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 Nov 1, 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.