Crawford Avenue Group Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071007124 Issued in IL

Legal business name

CRAWFORD AVENUE GROUP INC

Practice address

2530 Crawford Ave Ste 206
Evanston, IL 60201-4959

Phone

(847) 875-4411

NPI assigned

Jun 2, 2018

Organization subpart

No

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

Authorized official

Name

Kelli Klinger

Title

President

Phone

(847) 875-4411

Specialties & licenses 2

Addresses

Other identifiers 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Virginia Lynn Lazarus, PSY.D

  • Clinical Psychologist
  • Evanston, IL
  • NPI 1619019080
  NPD (past)

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

{
    "created_epoch": "1527897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527897600000",
    "number": "1013409366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CRAWFORD AVE STE 206",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CRAWFORD AVE STE 206",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014959",
            "telephone_number": "847-875-4411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2530 Crawford Ave Ste 212",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602014959",
            "country_code": "US",
            "telephone_number": "847-604-1945",
            "fax_number": "847-733-1217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CRAWFORD AVENUE GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-02",
        "last_updated": "2018-06-02",
        "status": "A",
        "authorized_official_last_name": "KLINGER",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-875-4411"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007124",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149003065",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ILLINOIS",
            "identifier": "0000603083",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1-NPI",
            "identifier": "1619019080",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1-NPI",
            "identifier": "1891819363",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cradle Society
• Cradle Society
• Alexandru Paul Craioveanu, MD
• Matthew Crane
• Lawrence Mark Craven, PH.D.
• Crawford Counseling Group
• Kaitlin Delaney Crawford, MD
• Natalie Cray
• Julie A. Creaden, APN-CNP
• Britton R Creelman, PH.D.

• Clinical Psychologist in Evanston, IL
• Providers in Evanston, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2018; 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.