Active NPI
Alexander C. Kristevski, PSY.D.
- Clinical Psychologist
- Crown Point, IN
National Provider Identifier
1063529709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301008595
- Practice address
- 9330 S Broadway
Abj-VA Outpatient Clinic
Crown Point, IN 46307 - Phone
- (219) 662-5098
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301008595 | MI | Primary |
Addresses
Primary practice location
9330 S Broadway
Abj-VA Outpatient Clinic
Crown Point, IN 46307
Mailing address
2834 Painted Leaf Dr
Crown Point, IN 46307-8132
Phone (219) 365-3960
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301008595 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063529709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2834 PAINTED LEAF DR",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463078132",
"telephone_number": "219-365-3960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9330 S BROADWAY",
"address_2": "ABJ-VA OUTPATIENT CLINIC",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "46307",
"telephone_number": "219-662-5098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISTEVSKI",
"first_name": "ALEXANDER",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301008595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crown Point, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.