Dr. Lara Beanblossom, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.006369 Issued in IL

Legal business name

DR. LARA BEANBLOSSOM, LLC

Practice address

30 N Michigan Ave
Suite 1004
Chicago, IL 60602-3402

Phone

(312) 385-9777

NPI assigned

Sep 6, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Lara Beanblossom, PSY.D.

Title

Licensed Clinical Psychologist

Phone

(312) 385-9777

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• K. Lara Beanblossom, PSYD

  • Clinical Psychologist
  • Winnetka, IL
  • NPI 1427184795
  Medicare reassignment NPD

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

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1497036321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE",
            "address_2": "SUITE 1004",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023402",
            "telephone_number": "312-385-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE",
            "address_2": "SUITE 1004",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023402",
            "telephone_number": "312-385-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. LARA BEANBLOSSOM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-06",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "BEANBLOSSOM",
        "authorized_official_first_name": "LARA",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "312-385-9777",
        "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": "071.006369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.