Christine V. Petersen, PSY D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071006311 Issued in IL

Practice address

2530 Crawford Ave Ste 212
Evanston, IL 60201-4959

Phone

(773) 469-7339

NPI assigned

Sep 20, 2006

Last updated

Feb 9, 2024By 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

Other names 1

• Christine Lynn Van Ess Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Grand Oaks Behavioral Health LLCGroup PAC ID 2163523903, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grand Oaks Behavioral Health LLC

  • Clinical Psychologist
  • Libertyville, IL
  • NPI 1124242359
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1033217385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CRAWFORD AVE STE 212",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014959",
            "telephone_number": "773-469-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CRAWFORD AVE STE 212",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014959",
            "telephone_number": "773-469-7339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Hollister Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600485266",
            "country_code": "US",
            "telephone_number": "847-549-1189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CHRISTINE",
        "middle_name": "V.",
        "credential": "PSY D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "VAN ESS",
            "middle_name": "LYNN",
            "credential": "PSY D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sara Perry
• Inna S Persina, M.D.
• Elene Pestvenidze
• Mariam Pestvenidze, M.D.
• Peter Werner MD
• Julia Peterson, APN-CNP
• Kristin Lily Peterson, MD
• Lance R Peterson, M.D.
• Timothy Peterson, MD
• Kyle Petty, MD

• 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 Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.