1588787279 NPI number — MRS. CORRI J FERDMAN LCSW, LLC

Table of content: MRS. CORRI J FERDMAN LCSW, LLC (NPI 1588787279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588787279 NPI number — MRS. CORRI J FERDMAN LCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERDMAN
Provider First Name:
CORRI
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588787279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 NORTH SHORE DR
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
LAKE BLUFF
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60044-2243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-793-0788
Provider Business Mailing Address Fax Number:
847-793-0789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 W EASTMAN ST
Provider Second Line Business Practice Location Address:
301
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60004-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-793-0788
Provider Business Practice Location Address Fax Number:
847-793-0789
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149009759 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 23620 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200866811 . This is a "CORPHEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "VALUE OPTIONS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 493-2415 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 793339000 . This is a "MAGELLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "LIFE SYNCH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200866811 . This is a "PHCS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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