Healthcare Provider Details

I. General information

NPI: 1720116254
Provider Name (Legal Business Name): ERIC K. CRABTREE-NELSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 N ARLINGTON HEIGHTS RD SUITE 205 EAST
ARLINGTON HEIGHTS IL
60004-3982
US

IV. Provider business mailing address

407 S MAIN ST
MOUNT PROSPECT IL
60056-3805
US

V. Phone/Fax

Practice location:
  • Phone: 847-764-9750
  • Fax:
Mailing address:
  • Phone: 847-764-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: