1568509412 NPI number — MS. DEBORAH M MILLER-LUNSFORD MSW

Table of content: MS. DEBORAH M MILLER-LUNSFORD MSW (NPI 1568509412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568509412 NPI number — MS. DEBORAH M MILLER-LUNSFORD MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER-LUNSFORD
Provider First Name:
DEBORAH
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1568509412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S EAST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60304-1322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-524-5344
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 E MAIN ST
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
ST CHARLES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60174-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-377-7226
Provider Business Practice Location Address Fax Number:
630-377-8826
Provider Enumeration Date:
01/31/2007

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:  149-005517 , 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)





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