1508821893 NPI number — MR. WALTER PETER HUMENICK LCSW

Table of content: MR. WALTER PETER HUMENICK LCSW (NPI 1508821893)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508821893 NPI number — MR. WALTER PETER HUMENICK LCSW

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
HUMENICK

Provider First Name:
WALTER

Provider Middle Name:
PETER

Provider Name Prefix Text:
MR.

Provider Name Suffix Text:

Provider Credential Text:
LCSW

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:
1508821893

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
09/11/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 78

Provider Second Line Business Mailing Address:
BOX 7362

Provider Business Mailing Address City Name:
APO

Provider Business Mailing Address State Name:
AP

Provider Business Mailing Address Postal Code:
96326

Provider Business Mailing Address Country Code:
JP

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 78

Provider Second Line Business Practice Location Address:
BOX 7362

Provider Business Practice Location Address City Name:
APO

Provider Business Practice Location Address State Name:
AP

Provider Business Practice Location Address Postal Code:
96326

Provider Business Practice Location Address Country Code:
JP

Provider Business Practice Location Address Telephone Number:
080348271

Provider Business Practice Location Address Fax Number:
08034271

Provider Enumeration Date:
04/19/2006

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: 101YA0400X , with the licence number: LISAC-11409 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Taxonomy code: 1041C0700X , with the licence number: LCSW-10817 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .