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
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/20/2024
Last updated
03/26/2025
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