1033786058 NPI number — MR. JOHN THOMAS HARDENBERGH LGSW

Table of content: MR. JOHN THOMAS HARDENBERGH LGSW (NPI 1033786058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033786058 NPI number — MR. JOHN THOMAS HARDENBERGH LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDENBERGH
Provider First Name:
JOHN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LGSW
Provider Gender Code:
M

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:
1033786058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2015 CONNECTICUT AVE NW
Provider Second Line Business Mailing Address:
STE 1000
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-744-8187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2015 CONNECTICUT AVE NW
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-744-8187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2021

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:  LG50082652 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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