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Organization
FORT HEALTH MEDICAL GROUP PA
Active
Organization
FORT HEALTH MEDICAL GROUP PA
Active
Other names
Fort Health Medical Group of IL
Organization subpart
No
Provider details
NPI number
Authorized official
TRACI CROSBY (CREDENTIALING MANAGER)
(201) 503-4815
Entity
Organization
Contact information
Practice address
600 S 2ND ST STE 404, SPRINGFIELD, IL 62704-2542
(201) 208-2616
(973) 381-5773
Mailing address
613 WASHINGTON BLVD # 1297, JERSEY CITY, NJ 07310-2900
(201) 208-2616
(973) 381-5773
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/20/2024
Last updated
03/26/2025
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