Provider Demographics
NPI:1992321368
Name:MEAD, CRAIG (MSW, LCSW, LCPC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MEAD
Suffix:
Gender:M
Credentials:MSW, LCSW, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 N BROADWAY ST # 164
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4235
Mailing Address - Country:US
Mailing Address - Phone:312-918-2885
Mailing Address - Fax:
Practice Address - Street 1:5601 N SHERIDAN RD APT 13C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4865
Practice Address - Country:US
Practice Address - Phone:312-925-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012616101YP2500X
IL149.0188931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty