Center for Grief and Traumatic Loss, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

CENTER FOR GRIEF AND TRAUMATIC LOSS, LLC

Practice address

1144 Harms Ave
Libertyville, IL 60048-2524

Phone

(847) 680-0279

NPI assigned

May 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Allan L. Botkin, PSY.D.

Title

Director

Phone

(847) 680-0279

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366655813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1144 HARMS AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482524",
            "telephone_number": "847-680-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1144 HARMS AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482524",
            "telephone_number": "847-680-0279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR GRIEF AND TRAUMATIC LOSS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOTKIN",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-680-0279",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chet E Caruth, LSLP
• Caryn Kedzierski
• J Eric D Castro, MD
• Lauren Cavelli, MA, LCPC, NCC
• John Lee Cecilia, LCSW
• Center for Pain Control, P.C.
• Centerpointe Cpe, Inc.
• Cepamerica Illinois LLP
• Robyn Cepek, L.AC.
• Christina R Cerk, M.A, LCPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.