1295809986 NPI number — CORRI FERDMAN LCSW LLC

Table of content: MICHAEL STEWART BOGGS DDS (NPI 1326133380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295809986 NPI number — CORRI FERDMAN LCSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORRI FERDMAN LCSW LLC
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:
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:
1295809986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 W EASTMAN ST
Provider Second Line Business Mailing Address:
301
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60004-5937
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:
900 NORTH SHORE DR
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
LAKE BLUFF
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60044-2243
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:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FERDMAN
Authorized Official First Name:
CORRI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
LCSW
Authorized Official Telephone Number:
847-793-0788

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4932415 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".