1184024416 NPI number — MAREN W. DEAVER, LCSW PLLC

Table of content: JERRIE DEE HARVEY LPC, CDC1 (NPI 1073032306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184024416 NPI number — MAREN W. DEAVER, LCSW PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAREN W. DEAVER, LCSW PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1184024416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 GREGORY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMETTE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60091-3236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-840-9719
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2530 CRAWFORD AVE STE 219
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-4959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-840-9719
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DEAVER
Authorized Official First Name:
MAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
847-840-9719

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.014024 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 149.014024 . This is a "LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com