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General NPI Number Information
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NPI Number | 1992321368
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Entity Type | Individual
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Provider Name | CRAIG MEAD MSW, LCSW, LCPC
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Gender | Male
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 5601 N SHERIDAN RD APT 13C
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City | CHICAGO
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State | IL
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Zip | 60660-4865
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Country | US
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Telephone | 312-925-4595
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Fax |
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Provider Business Mailing Address
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Address Line | 3712 N BROADWAY ST # 164
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City | CHICAGO
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State | IL
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Zip | 60613-4235
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Country | US
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Telephone | 312-918-2885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.012616
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.018893
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License Number State | IL
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