Active NPI
Mary Sue P Lafferty, PHD
- Clinical Psychologist
- Evanston, IL
National Provider Identifier
1700969060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071004575
- Practice address
- 2530 Crawford Ave
#304
Evanston, IL 60201-4970 - Phone
- (847) 475-8625
- Fax
- (847) 869-8116
- NPI assigned
- Oct 23, 2006
- Sex
- Female
- 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 | 071004575 | IL | Primary |
Addresses
Primary practice location
2530 Crawford Ave
#304
Evanston, IL 60201-4970
Mailing address
2530 Crawford Ave
#304
Evanston, IL 60201-4970
Phone (847) 475-8625
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001673728 | Other | IL | BLUE CROSS |
| 245190 | Medicaid | IL |
Other names 1
- Dr. Sue P Lafferty
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 31, 2016 through Jan 31, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071004575 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421366400000",
"number": "1700969060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2530 CRAWFORD AVE",
"address_2": "#304",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014970",
"telephone_number": "847-475-8625",
"fax_number": "847-869-8116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2530 CRAWFORD AVE",
"address_2": "#304",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014970",
"telephone_number": "847-475-8625",
"fax_number": "847-869-8116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAFFERTY",
"first_name": "MARY SUE",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-23",
"last_updated": "2015-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071004575",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "0001673728",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "245190",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUE",
"last_name": "LAFFERTY",
"middle_name": "P",
"prefix": "DR.",
"credential": "PH.D.",
"code": "2",
"type": "Professional Name"
}
]
}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 Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.