Individual provider Active NPI

Lucy Rickspoone, PSY. D.

  • Clinical Psychologist
  • Libertyville, IL
National Provider Identifier
1164933123
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071010263 Issued in IL
Practice address
1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312
Phone
(847) 816-6335
NPI assigned
Oct 18, 2017
Last updated
Jun 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3960-57 WI
Clinical Psychologist 103TC0700X 071010263 IL Primary
Marriage & Family Therapist 106H00000X 166001364 IL

Addresses

Primary practice location

1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312

Mailing address

2715 Central St Apt 3S
Evanston, IL 60201-1261

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL lrickspoone.bansalneuro@gmail.com

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20211110001749 IL Practitioner - Clinical Psychologist 8527457688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1860 W Winchester Rd
Suite 106
Libertyville, IL 60048-5312
Phone (847) 816-6335

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071010263ILMDClinical Psychologist
3960-57WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ganesha Institute of Neurology and Psychiatry SC CurrentSince Jul 29, 2021 Accepting new patients
Ganesha Institute of Neurology and Psychiatry SC CurrentSince Jul 29, 2021 Accepting new patients

Locations

1850 W Winchester Rd
Ste 115
Libertyville, IL 60048
Phone (847) 816-6335

1860 W Winchester Rd
Ste 106
Libertyville, IL 60048
Phone (847) 599-0715

Interoperability endpoints

  • Direct secure messaging: lucy.rickspoone.1@9664.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1164933123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 CENTRAL ST APT 3S",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 W WINCHESTER RD STE 106",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485312",
            "telephone_number": "847-816-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKSPOONE",
        "first_name": "LUCY",
        "name_prefix": "Dr.",
        "credential": "PSY. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-18",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3960-57",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010263",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166001364",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "lrickspoone.bansalneuro@gmail.com",
            "affiliation": "N",
            "address_1": "1860 W Winchester Rd Ste 106",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600485312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

Verify at the official NPI Registry.