Provider Demographics
NPI:1972256394
Name:BRAND PADILLA, KYLE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:BRAND PADILLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W JACKSON BLVD STE 1700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3597
Mailing Address - Country:US
Mailing Address - Phone:646-453-6777
Mailing Address - Fax:833-900-1747
Practice Address - Street 1:111 W JACKSON BLVD STE 1700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3597
Practice Address - Country:US
Practice Address - Phone:646-453-6777
Practice Address - Fax:833-900-1747
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0218041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical