Active NPI
Robert W Cavanagh, PH.D
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1467576363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Practice address
- 435 W Diversey Pkwy
Chicago, IL 60614-6163 - Phone
- (708) 798-9313
- Fax
- (708) 798-9312
- NPI assigned
- Mar 17, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | IL | Primary |
Addresses
Primary practice location
435 W Diversey Pkwy
Chicago, IL 60614-6163
Mailing address
18001 Baker Ave
Country Club Hills, IL 60478-5046
Phone (708) 798-9313
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001673536 | Other | IL | BLUE CROSS BLUE SHIELDPPO |
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 |
|---|---|---|---|
| 071-002798 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467576363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18001 BAKER AVE",
"city": "COUNTRY CLUB HILLS",
"state": "IL",
"postal_code": "604785046",
"telephone_number": "708-798-9313",
"fax_number": "708-798-9312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 W DIVERSEY PKWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606146163",
"telephone_number": "708-798-9313",
"fax_number": "708-798-9312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVANAGH",
"first_name": "ROBERT",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELDPPO",
"identifier": "0001673536",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, 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.