James Jeffrey Crisco, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

613-057 Issued in WI

Practice address

3636 N 124TH St
Suite 200
Wauwatosa, WI 53222-2125

Phone

(414) 476-9755

Fax

(414) 476-3413

NPI assigned

Jul 23, 2008

Last updated

Apr 22, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240358400000",
    "number": "1013172600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 N 124TH ST",
            "address_2": "SUITE 200",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532222125",
            "telephone_number": "414-476-9755",
            "fax_number": "414-476-3413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 N 124TH ST",
            "address_2": "SUITE 200",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532222125",
            "telephone_number": "414-476-9755",
            "fax_number": "414-476-3413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISCO",
        "first_name": "JAMES",
        "middle_name": "JEFFREY",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-23",
        "last_updated": "2009-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WI",
            "license": "613-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39010900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lauren Croal, D.P.T.
• Mary A Crowder, RN
• John Crowe, P.T., L.A.T.
• Steven Croyle, PA

• Clinical Child & Adolescent Psychologist in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Clinical Child & Adolescent Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2009; 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.