Provider Demographics
NPI:1407816036
Name:CRANE, ADAM G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:G
Last Name:CRANE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 W CENTRAL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2490
Mailing Address - Country:US
Mailing Address - Phone:847-255-9697
Mailing Address - Fax:847-255-3206
Practice Address - Street 1:1614 W CENTRAL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2490
Practice Address - Country:US
Practice Address - Phone:847-255-9697
Practice Address - Fax:847-255-3206
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006159103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071006159Medicaid
IL071006159Medicaid