Cedar Hollow – Credentialing
Provider enrollment tracking across the three Cedar Hollow groups
| Provider name | Group | Credential | Provider NPI | CAQH # | State licensure | License status | License expires | Payer | Status | Application ID | Submitted | SSN |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Owen Fitzgerald | Oak Park | LCSW | 1342366712 | 20554371 | IL LCSW 149.012345 | Not checked | Larkspur Health Plan | Ready to check | Restricted | |||
| Amara Nwosu | Naperville | PMHNP | 1768426846 | 20562290 | IL APRN 209.018841 | Not checked | Larkspur Health Plan | Ready to check | Restricted | |||
| Leo Martins | Naperville | LCPC | 1563212233 | 20570209 | IL LCPC 180.015530 | Not checked | Larkspur Health Plan | Ready to check | Restricted | |||
| Hannah Weiss | Naperville | LCSW | 1079244026 | 20578128 | IL LCSW 149.034471 | Not checked | Larkspur Health Plan | Ready to check | Restricted | |||
| Rosa Delgado | Evanston | LCSW | 1859952890 | 20586047 | IL LCSW 149.028830 | Active | 11/30/2027 | Larkspur Health Plan | Submitted | LHP-2026-104233 | 10/14/2026 | Restricted |
| Ethan Park | Oak Park | LCPC | 1031372159 | 20593966 | IL LCPC 180.011207 | Active | 03/31/2027 | Prairie Mutual | Submitted | PM-55102 | 10/02/2026 | Restricted |
| Nadia Haddad | Naperville | PsyD | 1010928159 | 20601885 | IL Psychologist 071.007756 | Active | 09/30/2028 | Larkspur Health Plan | Submitted | LHP-2026-103871 | 09/29/2026 | Restricted |
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