1437209525 NPI number — DEBORAH L WILLIAMS LCSW

Table of content: DEBORAH L WILLIAMS LCSW (NPI 1437209525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437209525 NPI number — DEBORAH L WILLIAMS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
DEBORAH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1437209525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1814 W 500 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46952-9107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-662-9971
Provider Business Mailing Address Fax Number:
765-651-6563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1091 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WABASH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46992-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-563-4407
Provider Business Practice Location Address Fax Number:
260-563-6440
Provider Enumeration Date:
01/11/2007

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:  34003856A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: IN0017671 . This is a "TRICARE PROVIDER ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000004027 . This is a "MPLAN ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000317611 . This is a "GENCORP PROVIDER ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0007186320 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 088367428001 . This is a "GENERAL LISCENCE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000183247 . This is a "ANTHEM PROVIDER ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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