Active NPI
Gregory Scott Crisenbery, PSY.D.
- Clinical Psychologist
- Evanston, IL
National Provider Identifier
1972545671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071-005718
- Practice address
- 708 Church St
Evanston, IL 60201-3875 - Phone
- (847) 686-4000
- Fax
- (847) 686-4000
- NPI assigned
- Jun 10, 2006
- 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 | 071-005718 | IL | Primary |
Addresses
Primary practice location
708 Church St
Evanston, IL 60201-3875
Mailing address
324 Asbury Ave
Evanston, IL 60202-3204
Phone (847) 869-3148
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-005718 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspen Behavioral Care | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251244800000",
"number": "1972545671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 ASBURY AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602023204",
"telephone_number": "847-869-3148",
"fax_number": "847-686-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "708 CHURCH ST",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602013875",
"telephone_number": "847-686-4000",
"fax_number": "847-686-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRISENBERY",
"first_name": "GREGORY",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-10",
"last_updated": "2009-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-005718",
"primary": true
}
],
"identifiers": [],
"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 Aug 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.