Active NPI
Bernard Raden, PHD
- Clinical Psychologist
- Evanston, IL
National Provider Identifier
1184847600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 721571
- Practice address
- 1023 Maple
Evanston, IL 60202 - Phone
- (847) 864-2728
- Fax
- (847) 864-2728
- NPI assigned
- Apr 11, 2007
- 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 | 721571 | IL | Primary |
Addresses
Primary practice location
1023 Maple
Evanston, IL 60202
Mailing address
1023 Maple
Evanston, IL 60202
Phone (847) 864-2728
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 069945X05850151548 | Other | IL | SMED SUPP PLANT |
| 069945 | Other | IL | BLUE CROSS |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 721571 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184847600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1023 MAPLE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "60202",
"telephone_number": "847-864-2728",
"fax_number": "847-864-2728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1023 MAPLE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "60202",
"telephone_number": "847-864-2728",
"fax_number": "847-864-2728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADEN",
"first_name": "BERNARD",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "721571",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SMED SUPP PLANT",
"identifier": "069945X05850151548",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "069945",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
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.